Provider Demographics
NPI:1093076267
Name:OBEKPA-AGWADA, LINDA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:OBEKPA-AGWADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:2400 BALFOUR RD STE 201
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4952
Practice Address - Country:US
Practice Address - Phone:925-308-8112
Practice Address - Fax:925-308-8710
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202067207Q00000X
CT54656207Q00000X
CAA148019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine