Healthcare Provider Details

I. General information

NPI: 1033320148
Provider Name (Legal Business Name): LINDA JOY VANLINT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E BROADWAY
GLENDALE CA
91205-1315
US

IV. Provider business mailing address

1818 VERDUGO BLVD SUITE 200
GLENDALE CA
91208-1403
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-1088
  • Fax: 818-790-1778
Mailing address:
  • Phone: 818-790-1088
  • Fax: 818-790-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: