Provider Demographics
NPI:1609192962
Name:MISCH, LINDA (OMD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:MISCH
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 CARTER AVE
Mailing Address - Street 2:#133
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4944
Mailing Address - Country:US
Mailing Address - Phone:949-375-6418
Mailing Address - Fax:
Practice Address - Street 1:487 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5200
Practice Address - Country:US
Practice Address - Phone:949-375-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13486171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist