Provider Demographics
NPI:1477546125
Name:LINDA R OLAFSON MD INC
Entity Type:Organization
Organization Name:LINDA R OLAFSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-944-2986
Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:#101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:760-944-2986
Mailing Address - Fax:760-479-0875
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:#101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-944-2986
Practice Address - Fax:760-479-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90523Medicare UPIN