Provider Demographics
NPI:1982223103
Name:LEKETTEY, LAMBERT K
Entity Type:Individual
Prefix:
First Name:LAMBERT
Middle Name:K
Last Name:LEKETTEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 GROVE WAY APT 18
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-7115
Mailing Address - Country:US
Mailing Address - Phone:513-302-7272
Mailing Address - Fax:
Practice Address - Street 1:2481 GROVE WAY APT 18
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7115
Practice Address - Country:US
Practice Address - Phone:513-302-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver