Provider Demographics
NPI:1124353057
Name:LINDA GERRITS M D INC A PROFESSIONAL CORP
Entity type:Organization
Organization Name:LINDA GERRITS M D INC A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERRITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-494-7710
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-494-7710
Mailing Address - Fax:805-494-7793
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:SUITE 207
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-494-7710
Practice Address - Fax:805-494-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55503207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G555030Medicaid
CA00G555030Medicaid
CAG55503Medicare PIN