=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164048807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDELL KRPAN MALONEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2020
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 STANISLAUS AVE
-----------------------------------------------------
City | ANGELS CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95222-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-736-0813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 95
-----------------------------------------------------
City | MURPHYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95247-0095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1172481
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------