Basic Information
| Provider Information | |||||||||
| NPI: | 1881294528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEMUS CARPIO | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 N MCDONNELL AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900221111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233010248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 N BRAND BLVD # 100 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912031221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472862600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | Y |
No ID Information.