Healthcare Provider Details

I. General information

NPI: 1306173109
Provider Name (Legal Business Name): LINDA LUONG M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ELM ST
SAN CARLOS CA
94070-3018
US

IV. Provider business mailing address

600 ELM ST
SAN CARLOS CA
94070-3018
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: