Provider Demographics
NPI:1588985170
Name:MARK S LINAM DPM, A PROFESSIONAL CORP
Entity type:Organization
Organization Name:MARK S LINAM DPM, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LINAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-868-0787
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-633-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK S LINAM DPM, A PROFESSIONAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-17
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site