Provider Demographics
NPI:1700976024
Name:EVERETT, LIDIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:ELIZABETH
Last Name:EVERETT
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 1:1267 PALOMINO RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4243
Mailing Address - Country:US
Mailing Address - Phone:760-728-5372
Mailing Address - Fax:760-728-5972
Practice Address - Street 1:1267 PALOMINO RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4243
Practice Address - Country:US
Practice Address - Phone:760-728-5372
Practice Address - Fax:760-728-5972
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27580207R00000X
CAA31535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA26521Medicare UPIN
AZZ64928Medicare ID - Type Unspecified