Healthcare Provider Details

I. General information

NPI: 1801255955
Provider Name (Legal Business Name): LINDA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

IV. Provider business mailing address

1400 E 52ND ST
LONG BEACH CA
90805-6106
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4545
  • Fax: 562-862-7205
Mailing address:
  • Phone: 562-756-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1213490915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: