Provider Demographics
NPI:1619413143
Name:PAYNE, LINDSEY DEANNE (LAC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DEANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:407 S DITMAR ST
Mailing Address - Street 2:120
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4028
Mailing Address - Country:US
Mailing Address - Phone:760-566-7848
Mailing Address - Fax:
Practice Address - Street 1:407 S DITMAR ST
Practice Address - Street 2:120
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4028
Practice Address - Country:US
Practice Address - Phone:760-566-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist