Provider Demographics
NPI:1073899381
Name:PONGRACZ, LINDA DIANE (LVN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:PONGRACZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26895 ALISO CREEK RD
Mailing Address - Street 2:#431
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-887-2928
Mailing Address - Fax:
Practice Address - Street 1:26895 ALISO CREEK RD
Practice Address - Street 2:#431
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5301
Practice Address - Country:US
Practice Address - Phone:949-887-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259886164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse