Provider Demographics
NPI:1174334254
Name:LAMB, PRESTON
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:LAMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 E GUADALUPE RD APT 1036
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7713
Mailing Address - Country:US
Mailing Address - Phone:520-333-9753
Mailing Address - Fax:
Practice Address - Street 1:5151 E GUADALUPE RD APT 1036
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7713
Practice Address - Country:US
Practice Address - Phone:520-333-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04946828342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company