MEDICARE: LINDA L. QUACH PNP

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	163W00000X	Registered Nurse	716780-1	NY
2	163W00000X	Registered Nurse	RN95145098	CA
3	363LP0200X	Pediatric Nurse Practitioner	F382814-1	NY
4	363LN0000X	Neonatal Nurse Practitioner	NP95013206	CA
5	363LP0200X	Pediatric Nurse Practitioner	NP95013206	CA

General Provider Information

NPI Number	:	1275053811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L. QUACH PNP

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY # MC5008
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-5818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-5818
Fax Number	:

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

Provider Enumeration Date	:	06/25/2017
Last Update Date	:	01/19/2026

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