=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851181069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINZY MARIE SOUSA PPS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 E SIERRA WAY
-----------------------------------------------------
City | DINUBA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93618-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-595-7360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1327 E EL MONTE WAY
-----------------------------------------------------
City | DINUBA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93618-1825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-595-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 210017365
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------