MEDICARE: MRS. LINDA MARIA WORTHAM LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN259999	CA

General Provider Information

NPI Number	:	1174950323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA MARIA WORTHAM LVN

Provider Business Mailing Address
First Line	:	8264 LARKDALE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2814
Country	:	US
Telephone Number	:	858-874-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	8264 LARKDALE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2814
Country	:	US
Telephone Number	:	858-874-4451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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