Provider Demographics
NPI:1427691567
Name:LINDLEY, OPHELIA RAYCHELLE
Entity type:Individual
Prefix:
First Name:OPHELIA
Middle Name:RAYCHELLE
Last Name:LINDLEY
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 1:4781 N POLK AVE APT 195
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-5344
Mailing Address - Country:US
Mailing Address - Phone:951-380-0780
Mailing Address - Fax:
Practice Address - Street 1:14124 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7906
Practice Address - Country:US
Practice Address - Phone:682-344-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-19-101910106S00000X
TX246Z00000X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other