Healthcare Provider Details

I. General information

NPI: 1134053689
Provider Name (Legal Business Name): LINDA PARKS RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROWLAND WAY STE 220
NOVATO CA
94945-5056
US

IV. Provider business mailing address

1966 LAS GALLINAS AVE
SAN RAFAEL CA
94903-1740
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-7578
  • Fax: 844-733-2762
Mailing address:
  • Phone: 650-725-7578
  • Fax: 844-733-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number341004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: