Provider Demographics
NPI:1518931856
Name:WARREN-WATSON, LINDA ADELE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ADELE
Last Name:WARREN-WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1729 WEST AVE J.
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-723-0270
Mailing Address - Fax:661-949-6948
Practice Address - Street 1:1729 WEST AVE J.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-723-0270
Practice Address - Fax:661-949-6948
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC400790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C400790Medicaid
CA770314738OtherBLUE CROSS
CA00C400790Medicare ID - Type Unspecified
CA770314738OtherBLUE CROSS