Provider Demographics
NPI:1114029626
Name:LINDAS SPECIALTY SHOP INC
Entity Type:Organization
Organization Name:LINDAS SPECIALTY SHOP INC
Other - Org Name:A PRIVATE AFFAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BRAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-374-2293
Mailing Address - Street 1:1321 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2821
Mailing Address - Country:US
Mailing Address - Phone:805-374-2293
Mailing Address - Fax:805-374-2295
Practice Address - Street 1:1321 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 122
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2821
Practice Address - Country:US
Practice Address - Phone:805-374-2293
Practice Address - Fax:805-374-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4194040001Medicare ID - Type UnspecifiedMEDICARE ID