Provider Demographics
NPI:1508914276
Name:HARVEY, LYNDA M (LAC, OMD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9533 BUNDY DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2769
Mailing Address - Country:US
Mailing Address - Phone:619-322-9200
Mailing Address - Fax:619-258-2619
Practice Address - Street 1:6629 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1008
Practice Address - Country:US
Practice Address - Phone:619-322-9200
Practice Address - Fax:858-278-8784
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3040171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALA3040OtherLICENSE NUMBER