Provider Demographics
NPI:1568420750
Name:FOSHAGEN, LINDA KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAY
Last Name:FOSHAGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KAY
Other - Last Name:FOSHAGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:225 COLFAX AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6810
Mailing Address - Country:US
Mailing Address - Phone:530-271-7070
Mailing Address - Fax:530-271-7259
Practice Address - Street 1:225 COLFAX AVENUE
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6810
Practice Address - Country:US
Practice Address - Phone:530-271-7070
Practice Address - Fax:530-271-7259
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA141531OtherMEDICARE PTAN - RMA
CAB58250Medicare UPIN