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NPI Code Detail

MEDICARE: MS. LYNDA BASILE STACK RN

MEDICARE: MS. LYNDA BASILE STACK RN
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
1363LF0000XFamily Nurse Practitioner7723CA

General Provider Information

NPI Number : 1659405306
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LYNDA BASILE STACK RN
Provider Business Mailing Address
First Line : 1406 N BENTON WAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-2217
Country : US
Telephone Number : 323-395-4845
Fax Number :
Provider Business Practice Location Address
First Line : 6043 HOLLYWOOD BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-5411
Country : US
Telephone Number : 323-337-1770
Fax Number : 323-337-1784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 06/27/2014

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