Healthcare Provider Details

I. General information

NPI: 1043241052
Provider Name (Legal Business Name): LINK INSTITUTE FOR WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S MAIN ST STE 100
ORANGE CA
92868-3851
US

IV. Provider business mailing address

541 W COLORADO ST STE 207
GLENDALE CA
91204-3631
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-0101
  • Fax: 714-541-0450
Mailing address:
  • Phone: 323-942-7257
  • Fax: 323-488-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG25774
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXWELL THORSBAKKEN
Title or Position: DIRECTOR
Credential:
Phone: 323-942-7257