Provider Demographics
NPI:1497868657
Name:MORFORD, LINDA DIANNE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANNE
Last Name:MORFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 ZUMSTEIN CT
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-3118
Mailing Address - Country:US
Mailing Address - Phone:209-599-8406
Mailing Address - Fax:
Practice Address - Street 1:1045 5TH ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4204
Practice Address - Country:US
Practice Address - Phone:209-827-4747
Practice Address - Fax:209-827-5831
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497868657Medicaid
CADJ378ZMedicare PIN
CA1497868657Medicaid