=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104356518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA VANESSA BOCANEGRA ENGLISH DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2017
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1975 GLENN MITCHELL DR STE 202
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-0167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-507-8610
-----------------------------------------------------
Fax | 757-510-9350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1975 GLENN MITCHELL DR STE 202
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-0167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-507-8610
-----------------------------------------------------
Fax | 757-510-9350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 11019539A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 0102208665
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------