Healthcare Provider Details

I. General information

NPI: 1043771678
Provider Name (Legal Business Name): LINDA SARA BLUM GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CLAY ST STE 339
SAN FRANCISCO CA
94115-1931
US

IV. Provider business mailing address

PO BOX 7999
SAN FRANCISCO CA
94120-7999
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3190
  • Fax: 415-369-1390
Mailing address:
  • Phone: 415-600-3190
  • Fax: 415-369-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number450007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: