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Individual

DR. LYLE RICHARD JUSTESEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1201 ALHAMBRA BLVD, SUITE 210, SACRAMENTO, CA 95816-5238
(916) 731-7775
(916) 731-7785
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
(800) 470-0071

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G74319
CA
2083X0100X
Occupational Medicine Physician
Primary
G73419
CA

Other

Enumeration date
08/31/2006
Last updated
06/15/2012
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