Provider Demographics
NPI:1851479695
Name:NELSON SWAIN, LYNDA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:M
Last Name:NELSON SWAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LYNDA
Other - Middle Name:M
Other - Last Name:NELSON-CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 CALIFORNIA DRIVE, 3E, ROOM 13
Mailing Address - Street 2:
Mailing Address - City:YOUNTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94599-1412
Mailing Address - Country:US
Mailing Address - Phone:707-944-4506
Mailing Address - Fax:707-944-5052
Practice Address - Street 1:100 CALIFORNIA DRIVE
Practice Address - Street 2:
Practice Address - City:YOUNTVILLE
Practice Address - State:CA
Practice Address - Zip Code:94599-1412
Practice Address - Country:US
Practice Address - Phone:707-944-4660
Practice Address - Fax:707-944-5052
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A609240Medicaid
CA00A609240Medicaid
00A609240Medicare ID - Type Unspecified