Provider Demographics
NPI:1144665746
Name:LYONS, SUSAN B
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:LYONS
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 1:6114 HOLLAND CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3084
Mailing Address - Country:US
Mailing Address - Phone:909-519-2274
Mailing Address - Fax:
Practice Address - Street 1:9540 CENTER AVE
Practice Address - Street 2:100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5840
Practice Address - Country:US
Practice Address - Phone:909-980-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator