Provider Demographics
NPI:1184902934
Name:LOCKHART, GERRY LYNN
Entity type:Individual
Prefix:MR
First Name:GERRY
Middle Name:LYNN
Last Name:LOCKHART
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 1:4107 SANTA ROSALIA DR APT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5024
Mailing Address - Country:US
Mailing Address - Phone:323-290-4378
Mailing Address - Fax:
Practice Address - Street 1:3881 S WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062
Practice Address - Country:US
Practice Address - Phone:323-290-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator