MEDICARE: MRS. ALBA GUADALUPE LINAREZ

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1366683427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALBA GUADALUPE LINAREZ

Provider Business Mailing Address
First Line	:	P.O. BOX 1176
Second Line	:	1404 COMMONWEALTH AVE
City	:	BRONX
State	:	NY
Zip	:	10472
Country	:	US
Telephone Number	:	646-337-8124
Fax Number	:	718-931-0807

Provider Business Practice Location Address
First Line	:	1404 COMMONWEALTH AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472
Country	:	US
Telephone Number	:	646-337-8124
Fax Number	:	718-931-0807

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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