Healthcare Provider Details

I. General information

NPI: 1144544412
Provider Name (Legal Business Name): LINDI H. VANDERWALDE, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 WILSHIRE BLVD
BEVERLY HILLS CA
90211-1958
US

IV. Provider business mailing address

1880 CENTURY PARK E SUITE 200
LOS ANGELES CA
90067-1600
US

V. Phone/Fax

Practice location:
  • Phone: 310-432-8900
  • Fax:
Mailing address:
  • Phone: 310-289-9333
  • Fax: 310-552-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94946
License Number StateCA

VIII. Authorized Official

Name: DR. LINDI H VANDERWALDE
Title or Position: SURGEON
Credential: MD
Phone: 310-421-8225