Provider Demographics
NPI:1275533473
Name:LINDBERG, CAROL ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:LINDBERG
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 1:344 TEJON PL
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1204
Mailing Address - Country:US
Mailing Address - Phone:310-378-0565
Mailing Address - Fax:310-378-0675
Practice Address - Street 1:344 TEJON PL
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1204
Practice Address - Country:US
Practice Address - Phone:310-378-0565
Practice Address - Fax:310-378-0675
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG215922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21592Medicare ID - Type Unspecified
CAE20152Medicare UPIN