Healthcare Provider Details

I. General information

NPI: 1487947958
Provider Name (Legal Business Name): JOHN DAX LINDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503-3410
US

IV. Provider business mailing address

PO BOX 277
BIEBER CA
96009-0277
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4501
  • Fax:
Mailing address:
  • Phone: 530-294-5241
  • Fax: 530-294-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA142898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.135917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: