Healthcare Provider Details

I. General information

NPI: 1356590608
Provider Name (Legal Business Name): LINETTE M SANDE LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINETTE SANDE MD

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 22-442 MDCC UCLA DEPT OF PEDIATRICS, INFECTIOUS DISEASE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE 22-442 MDCC UCLA DEPT OF PEDIATRICS, INFECTIOUS DISEASE
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5235
  • Fax: 310-206-4764
Mailing address:
  • Phone: 310-825-5235
  • Fax: 310-206-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA104229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: