Provider Demographics
NPI:1811434467
Name:LYNN, DEBORAH SUE
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SUE
Last Name:LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W. ARBOR DR.
Mailing Address - Street 2:UCSD GIFFORD OUTPATIENT CLINIC
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2421
Mailing Address - Country:US
Mailing Address - Phone:619-543-6904
Mailing Address - Fax:619-543-7013
Practice Address - Street 1:140 W. ARBOR DR.
Practice Address - Street 2:UCSD GIFFORD OUTPATIENT CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2421
Practice Address - Country:US
Practice Address - Phone:619-543-6904
Practice Address - Fax:619-543-7013
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist