Provider Demographics
NPI:1689901068
Name:LIGHTBRIDGE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LIGHTBRIDGE MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-458-2992
Mailing Address - Street 1:6155 CORNERSTONE CT E
Mailing Address - Street 2:SUITE #220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4737
Mailing Address - Country:US
Mailing Address - Phone:858-458-2992
Mailing Address - Fax:858-362-4027
Practice Address - Street 1:6155 CORNERSTONE CT E
Practice Address - Street 2:SUITE #220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4737
Practice Address - Country:US
Practice Address - Phone:858-458-2992
Practice Address - Fax:858-362-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACY415AOtherMEDICARE PTAN