Provider Demographics
NPI:1053345959
Name:LAMENDOLA, JACK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EDWARD
Last Name:LAMENDOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7248 S LAND PARK DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3660
Mailing Address - Country:US
Mailing Address - Phone:916-395-5226
Mailing Address - Fax:916-399-1569
Practice Address - Street 1:7248 S LAND PARK DR
Practice Address - Street 2:SUITE 113
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3660
Practice Address - Country:US
Practice Address - Phone:916-395-5226
Practice Address - Fax:916-399-1569
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00A37053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A370531Medicaid