Provider Demographics
NPI:1114167582
Name:MAVITY, LINDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:MAVITY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0698
Mailing Address - Country:US
Mailing Address - Phone:408-358-2511
Mailing Address - Fax:408-358-1009
Practice Address - Street 1:15055 LOS GATOS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2083
Practice Address - Country:US
Practice Address - Phone:408-358-2511
Practice Address - Fax:408-358-1009
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5684363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology