Provider Demographics
NPI:1992909873
Name:LINDBLAD, PAIGE (PAC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LINDBLAD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-642-8727
Mailing Address - Fax:949-642-5413
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:SUITE 333
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-642-8727
Practice Address - Fax:949-642-5413
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant