Provider Demographics
NPI:1568498095
Name:CEDERQUIST, LYNETTE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:C
Last Name:CEDERQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNETTE
Other - Middle Name:C
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10650 ARBOR HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4342
Mailing Address - Country:US
Mailing Address - Phone:858-558-9309
Mailing Address - Fax:858-657-8558
Practice Address - Street 1:9350 CAMPUS POINT DR
Practice Address - Street 2:MAIL CODE 0945
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0945
Practice Address - Country:US
Practice Address - Phone:858-657-8000
Practice Address - Fax:858-657-8558
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623240Medicaid
CAF02819Medicare UPIN
CA4112180001Medicare NSC
CA00G623240Medicaid