Healthcare Provider Details

I. General information

NPI: 1730115155
Provider Name (Legal Business Name): LINDA MAK, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 S IMPERIAL AVE
EL CENTRO CA
92243-4243
US

IV. Provider business mailing address

PO BOX 2678
EL CENTRO CA
92244-2678
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-0574
  • Fax: 760-353-0397
Mailing address:
  • Phone: 760-353-0574
  • Fax: 760-353-0397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA L MAK
Title or Position: DR
Credential: MD
Phone: 760-353-0574