Provider Demographics
NPI:1194119438
Name:ELDRIDGE, LYDIA MAISONET
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:MAISONET
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1310
Mailing Address - Country:US
Mailing Address - Phone:916-475-1266
Mailing Address - Fax:916-441-1600
Practice Address - Street 1:2230 9TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1310
Practice Address - Country:US
Practice Address - Phone:916-475-1266
Practice Address - Fax:916-441-1600
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator