Provider Demographics
NPI:1972646792
Name:NYMAN, LINDA HARUNO (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:HARUNO
Last Name:NYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 MECCA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4519
Mailing Address - Country:US
Mailing Address - Phone:818-363-6758
Mailing Address - Fax:
Practice Address - Street 1:5054 MECCA AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4519
Practice Address - Country:US
Practice Address - Phone:818-363-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415875163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ09117Medicare UPIN