Healthcare Provider Details

I. General information

NPI: 1750579348
Provider Name (Legal Business Name): LINDA MAK, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-900 HWY 111, STE 212
INDIAN WELLS CA
92210
US

IV. Provider business mailing address

PO BOX 5819
LA QUINTA CA
92248-5819
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-0209
  • Fax: 760-568-0184
Mailing address:
  • Phone: 760-568-0209
  • Fax: 760-568-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA51014
License Number StateCA

VIII. Authorized Official

Name: LINDA MAK
Title or Position: PRESIDENT, CEO
Credential: M.D.
Phone: 760-333-1418