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General NPI Number Information
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NPI Number | 1275569352
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Entity Type | Individual
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Provider Name | LINDA J BOUCHARD M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 520 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4720
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Country | US
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Telephone | 209-860-4393
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Fax | 209-650-0684
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Provider Business Mailing Address
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Address Line | 520 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4720
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Country | US
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Telephone | 209-860-4393
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Fax | 209-650-0684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G58369
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License Number State | CA
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