1871664987 NPI number — DR. LINDA MARLENE BOLLING DAVIS M.D.

Table of content: DR. LINDA MARLENE BOLLING DAVIS M.D. (NPI 1871664987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871664987 NPI number — DR. LINDA MARLENE BOLLING DAVIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
LINDA
Provider Middle Name:
MARLENE BOLLING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOLLING
Provider Other First Name:
LINDA
Provider Other Middle Name:
MARLENE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871664987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25982 PALA
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-6719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-600-8990
Provider Business Mailing Address Fax Number:
949-600-8998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25982 PALA
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-600-8990
Provider Business Practice Location Address Fax Number:
949-600-8998
Provider Enumeration Date:
11/11/2006

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:  A74559 , 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)





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