Provider Demographics
NPI:1033703251
Name:LINO, MARK ANTHONY
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:LINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13835 E HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:LOCKEFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95237-9422
Mailing Address - Country:US
Mailing Address - Phone:916-289-1337
Mailing Address - Fax:
Practice Address - Street 1:13835 E HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:LOCKEFORD
Practice Address - State:CA
Practice Address - Zip Code:95237-9422
Practice Address - Country:US
Practice Address - Phone:916-289-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide