Provider Demographics
NPI:1588760508
Name:NARVAEZ, LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:NARVAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 W JEFFERSON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7032
Mailing Address - Country:US
Mailing Address - Phone:310-838-3133
Mailing Address - Fax:310-838-3136
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7032
Practice Address - Country:US
Practice Address - Phone:310-838-3133
Practice Address - Fax:310-838-3136
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68202Medicare UPIN
CAG80435Medicare ID - Type Unspecified