Healthcare Provider Details

I. General information

NPI: 1689150120
Provider Name (Legal Business Name): MEDLINQ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 FAIRVIEW RD STE 100
COSTA MESA CA
92627-5671
US

IV. Provider business mailing address

8465 210TH ST W
LAKEVILLE MN
55044-8502
US

V. Phone/Fax

Practice location:
  • Phone: 888-447-8248
  • Fax:
Mailing address:
  • Phone: 651-269-2091
  • Fax: 888-447-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIAM MOLANI
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 866-522-5467