=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083633556
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA LINDHOLM-CARDINALE M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 W IMPERIAL HWY SUITE 203
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-357-0520
-----------------------------------------------------
Fax | 714-459-7014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 BEECHWOOD DR
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-357-0520
-----------------------------------------------------
Fax | 714-459-7014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC34252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------