Healthcare Provider Details

I. General information

NPI: 1811375488
Provider Name (Legal Business Name): LINCOLN DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 E LINCOLN AVE SUITE 102
ANAHEIM CA
92805-4366
US

IV. Provider business mailing address

151 KALMUS DR SUITE K-1
COSTA MESA CA
92626-5988
US

V. Phone/Fax

Practice location:
  • Phone: 714-384-3216
  • Fax: 714-388-3802
Mailing address:
  • Phone: 714-384-3216
  • Fax: 714-388-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name: LAURA LYNNE MACDONALD
Title or Position: CFO
Credential:
Phone: 714-384-3216