Healthcare Provider Details

I. General information

NPI: 1013059237
Provider Name (Legal Business Name): LINDA EMIETURE EDHERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

PO BOX 2468
CHINO HILLS CA
91709-0083
US

V. Phone/Fax

Practice location:
  • Phone: 760-552-6700
  • Fax:
Mailing address:
  • Phone: 512-656-0647
  • Fax: 909-606-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA90391
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: