Healthcare Provider Details

I. General information

NPI: 1033265780
Provider Name (Legal Business Name): LINDA M WASSERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ARBOR DRIVE MC 0639
SAN DIEGO CA
92103-0639
US

IV. Provider business mailing address

200 WEST ARBOR DRIVE MC 0639
SAN DIEGO CA
92103-0639
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-8955
  • Fax: 858-534-0269
Mailing address:
  • Phone: 858-534-8955
  • Fax: 858-534-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License NumberG67479
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberG67479
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG67479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: