1568420750 NPI number — DR. LINDA KAY FOSHAGEN DO

Table of content: DR. LINDA KAY FOSHAGEN DO (NPI 1568420750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568420750 NPI number — DR. LINDA KAY FOSHAGEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSHAGEN
Provider First Name:
LINDA
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSHAGEN
Provider Other First Name:
LINDA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568420750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 COLFAX AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945-6810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-271-7070
Provider Business Mailing Address Fax Number:
530-271-7259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 COLFAX AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-6810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-271-7070
Provider Business Practice Location Address Fax Number:
530-271-7259
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A4866 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CA141531 . This is a "MEDICARE PTAN - RMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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