Healthcare Provider Details

I. General information

NPI: 1093024861
Provider Name (Legal Business Name): LINDA ANNE RANK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CORPORATE DR STE 150
LADERA RANCH CA
92694-2136
US

IV. Provider business mailing address

777 CORPORATE DR STE 150
LADERA RANCH CA
92694-2136
US

V. Phone/Fax

Practice location:
  • Phone: 949-481-8881
  • Fax: 949-481-6666
Mailing address:
  • Phone: 949-481-8881
  • Fax: 949-481-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: