Healthcare Provider Details

I. General information

NPI: 1164657623
Provider Name (Legal Business Name): MARK S. LINAM, DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD SUITE 101
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD SUITE 101
PARAMOUNT CA
90723-5433
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-0976
  • Fax: 562-633-8470
Mailing address:
  • Phone: 562-633-0976
  • Fax: 562-633-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3500
License Number StateCA

VIII. Authorized Official

Name: GINA D RODRIGUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-633-0976