Basic Information
| Provider Information | |||||||||
| NPI: | 1568498095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CEDERQUIST | ||||||||
| FirstName: | LYNETTE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOCK | ||||||||
| OtherFirstName: | LYNETTE | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10650 ARBOR HEIGHTS LN | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921214342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585589309 | ||||||||
| FaxNumber: | 8586578558 | ||||||||
| Practice Location | |||||||||
| Address1: | 9350 CAMPUS POINT DR | ||||||||
| Address2: | MAIL CODE 0945 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920370945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586578000 | ||||||||
| FaxNumber: | 8586578558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G62324 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G623240 | 05 | CA | MEDICAID |