Healthcare Provider Details

I. General information

NPI: 1114090669
Provider Name (Legal Business Name): ROGER C LIND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23388 MULHOLLAND DR
WOODLAND HILLS CA
91364-2733
US

IV. Provider business mailing address

23388 MULHOLLAND DR
WOODLAND HILLS CA
91364-2733
US

V. Phone/Fax

Practice location:
  • Phone: 661-284-3100
  • Fax: 661-290-3310
Mailing address:
  • Phone: 661-284-3100
  • Fax: 661-290-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG42548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: