Provider Demographics
NPI:1255325742
Name:LINDQUIST, PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HOTEL CIR S
Mailing Address - Street 2:STE 250
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3428
Mailing Address - Country:US
Mailing Address - Phone:619-296-9781
Mailing Address - Fax:619-296-3711
Practice Address - Street 1:1545 HOTEL CIR S
Practice Address - Street 2:STE 250
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3428
Practice Address - Country:US
Practice Address - Phone:619-296-9781
Practice Address - Fax:619-296-3711
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY58020103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL58020OtherBLUE SHIELD PROVIDER ID
CACP58020Medicare ID - Type Unspecified