MEDICARE: NICOLE MALIA LINDSTROM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	25189	CA

General Provider Information

NPI Number	:	1073290664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MALIA LINDSTROM

Provider Business Mailing Address
First Line	:	2240 E PLAZA BLVD STE B-E
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-5164
Country	:	US
Telephone Number	:	661-210-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 E BONITA RD STE C
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3057
Country	:	US
Telephone Number	:	619-230-0855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	12/11/2025

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Directions to “ NICOLE MALIA LINDSTROM ” Practice Location

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