Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 20A10616 | CA |
N | 207Q00000X | Family Doctor | 20A10616 | CA |
NPI | 1578843793 |
---|---|
Provider Name | Dr. Krista Senness Lund |
First Address | Clovis, CA 93612-0303 |
Second Address | Clovis, CA 93612-0303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2011 |
Last Update Date | 12/06/2019 |