Basic Information
| Provider Information | |||||||||
| NPI: | 1982019485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMPEL | ||||||||
| FirstName: | JEREMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 SOQUEL AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950621323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314796603 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 BAY AVE | ||||||||
| Address2: | |||||||||
| City: | CAPITOLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950102186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314607333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 995259 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.