Provider Demographics
NPI:1316074529
Name:RICHARDS, LINDA SUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1534 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6346
Mailing Address - Country:US
Mailing Address - Phone:310-937-9612
Mailing Address - Fax:310-937-9612
Practice Address - Street 1:6330 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2610
Practice Address - Country:US
Practice Address - Phone:818-994-9822
Practice Address - Fax:818-994-9821
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA11678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant