Healthcare Provider Details

I. General information

NPI: 1689762650
Provider Name (Legal Business Name): LINDA VASSALLO C.R.N.F.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MARBLE CANYON CT
SAN RAMON CA
94582-4829
US

IV. Provider business mailing address

430 MARBLE CANYON CT
SAN RAMON CA
94582-4829
US

V. Phone/Fax

Practice location:
  • Phone: 925-735-6392
  • Fax: 925-735-6392
Mailing address:
  • Phone: 925-735-6392
  • Fax: 925-735-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number239561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: