Provider Demographics
NPI:1750367462
Name:STROMBERG, LYNETTE (MD)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:
Last Name:STROMBERG
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 1:13601 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3818
Mailing Address - Country:US
Mailing Address - Phone:510-231-9412
Mailing Address - Fax:510-231-9401
Practice Address - Street 1:13601 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3818
Practice Address - Country:US
Practice Address - Phone:510-231-9412
Practice Address - Fax:510-231-9401
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57324208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000Medicare UPIN