Healthcare Provider Details

I. General information

NPI: 1700123999
Provider Name (Legal Business Name): LINDA MULDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 113
SANTA BARBARA CA
93105-4377
US

IV. Provider business mailing address

20 EXECUTIVE PARK, SUITE 155
IRVINE CA
92614-4713
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7744
  • Fax: 805-682-3321
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG64510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: