Provider Demographics
NPI:1104679554
Name:MAEPA, LINDA (TRD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAEPA
Suffix:
Gender:X
Credentials:TRD
Other - Prefix:
Other - First Name:GOGO
Other - Middle Name:
Other - Last Name:PEBETSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SANGOMA
Mailing Address - Street 1:32 S RAYMOND AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1961
Mailing Address - Country:US
Mailing Address - Phone:650-241-2424
Mailing Address - Fax:650-241-2424
Practice Address - Street 1:32 S RAYMOND AVE STE 3
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1961
Practice Address - Country:US
Practice Address - Phone:650-241-2424
Practice Address - Fax:650-241-2424
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist