Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 00G533740 | CA |
N | 207ND0900X | Dermatopathologist | 00G533740 | CA |
N | 207NP0225X | Pediatric Dermatologist | 00G533740 | CA |
N | 207NS0135X | Procedural Dermatology | 00G533740 | CA |
NPI | 1558561563 |
---|---|
Provider Name | Dr. Mary Louise Lindae |
First Address | Fresno, CA 93710 |
Second Address | Fresno, CA 93710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070004431 | MEDICARE RAILROAD (01) | CA |
E75073 | (02) | CA |