MEDICARE: DR. PATRICIA LINDQUIST PH.D

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	103TC2200X	Clinical Child & Adolescent Psychologist	PSY58020	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00PL58020	OTHER	CA	BLUE SHIELD PROVIDER ID

General Provider Information

NPI Number	:	1255325742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA LINDQUIST PH.D

Provider Business Mailing Address
First Line	:	1545 HOTEL CIR S
Second Line	:	STE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3428
Country	:	US
Telephone Number	:	619-296-9781
Fax Number	:	619-296-3711

Provider Business Practice Location Address
First Line	:	1545 HOTEL CIR S
Second Line	:	STE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3428
Country	:	US
Telephone Number	:	619-296-9781
Fax Number	:	619-296-3711

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/21/2018

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