Provider Demographics
NPI:1649545328
Name:LAMBROSE, DANA LYNN (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:LAMBROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4848
Mailing Address - Country:US
Mailing Address - Phone:714-661-9032
Mailing Address - Fax:
Practice Address - Street 1:1055 WILSHIRE BLVD STE 1705
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5600
Practice Address - Country:US
Practice Address - Phone:714-661-9032
Practice Address - Fax:714-963-7302
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201508192NP-PP363LP0808X
CANPF 21628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP2162800Medicaid
CAGV698ZMedicare PIN