Healthcare Provider Details

I. General information

NPI: 1134282825
Provider Name (Legal Business Name): LINDA MAURINE SCHULTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80B VETERANS BLVD ACOMA-CANONCITO-LAGUNA INDIAN
SAN FIDEL NM
87049
US

IV. Provider business mailing address

80B VETERANS BLVD ACOMA-CANONCITO-LAGUNA INDIAN
SAN FIDEL NM
87049
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax:
Mailing address:
  • Phone: 505-552-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24771
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: