Provider Demographics
NPI:1568415669
Name:MAK, LINDA L (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:MAK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 5100
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-5100
Mailing Address - Country:US
Mailing Address - Phone:760-568-0209
Mailing Address - Fax:760-568-0184
Practice Address - Street 1:1703 ROSS AVE #212
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-568-0209
Practice Address - Fax:760-568-0184
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA51014207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF95148Medicare UPIN