Healthcare Provider Details

I. General information

NPI: 1518906239
Provider Name (Legal Business Name): JEFFREY ALAN LINDENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WEST HOSPITAL ROAD
FRENCH CAMP CA
95213
US

IV. Provider business mailing address

1524 MCHENRY AVENUE SUITE 150
MODESTO CA
95350-4569
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6440
  • Fax: 209-468-6962
Mailing address:
  • Phone: 209-571-8330
  • Fax: 209-491-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number641668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: