Provider Demographics
NPI:1508186032
Name:MCILVENA, LINDSEY RAPP SMITH (MD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAPP SMITH
Last Name:MCILVENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 2ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3275
Mailing Address - Country:US
Mailing Address - Phone:760-652-9060
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3275
Practice Address - Country:US
Practice Address - Phone:760-652-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1224502083P0901X
AZR72101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine