Healthcare Provider Details

I. General information

NPI: 1053471516
Provider Name (Legal Business Name): PLACENTIA LINDA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ROSE DR
PLACENTIA CA
92870-3802
US

IV. Provider business mailing address

2922 ALDERGROVE CT
FULLERTON CA
92835-4327
US

V. Phone/Fax

Practice location:
  • Phone: 714-993-2000
  • Fax:
Mailing address:
  • Phone: 714-255-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number467998
License Number StateCA

VIII. Authorized Official

Name: GINA DAW
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 714-255-1076