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Individual

AVA MARIE LAMM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LVN

Contact information

Practice address
12398 CUSTER ST, YUCAIPA, CA 92399-4452
(909) 797-4333
Mailing address
12398 CUSTER ST, YUCAIPA, CA 92399-4452
(909) 797-4333

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN164574
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CMCSUBQQ8
CMC ID
CA
01
EPS016730
MEDI-CAL PROVIDER NUMBER
CA
01
RVN004880
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
02/19/2008
Last updated
02/19/2008
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