Provider Demographics
NPI:1942682315
Name:SIEMON, LYNDA (ND)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:SIEMON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 UNIVERSITY AVE
Mailing Address - Street 2:28
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7640
Mailing Address - Country:US
Mailing Address - Phone:805-709-4182
Mailing Address - Fax:
Practice Address - Street 1:987 UNIVERSITY AVE
Practice Address - Street 2:28
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7640
Practice Address - Country:US
Practice Address - Phone:805-709-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-3952083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine