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General NPI Number Information
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NPI Number | 1790102440
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Entity Type | Individual
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Provider Name | LINDA STARK
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Gender | Female
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 27701 MURRIETA RD SPACE 186
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City | MENIFEE
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State | CA
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Zip | 92586-6301
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Country | US
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Telephone | 951-309-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 27701 MURRIETA RD SPACE 186
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City | MENIFEE
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State | CA
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Zip | 92586-6301
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Country | US
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Telephone | 951-309-1485
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | MTRN32610
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 572824
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 2006029133
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 231366
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License Number State | NC
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