Provider Demographics
NPI:1235747866
Name:LYNCH, JAMES VICTOR III (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VICTOR
Last Name:LYNCH
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HALE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3598
Mailing Address - Country:US
Mailing Address - Phone:916-595-4048
Mailing Address - Fax:
Practice Address - Street 1:910 HALE PL STE 102
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3598
Practice Address - Country:US
Practice Address - Phone:619-625-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58535363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program