Provider Demographics
NPI:1609814854
Name:WARNER, LINDA M (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:WARNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:ARRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:17871 SANTIAGO BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4118
Mailing Address - Country:US
Mailing Address - Phone:714-974-1362
Mailing Address - Fax:714-974-3145
Practice Address - Street 1:17871 SANTIAGO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-4118
Practice Address - Country:US
Practice Address - Phone:714-974-1362
Practice Address - Fax:714-974-3145
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
056976OtherHEALTH NET ID #
080050783OtherRAILROAD
CA00AX61110Medicaid
CA20A6111OtherLICENSE
020A61110OtherBLUE SHIELD ID #
CA20A6111OtherLICENSE
CAW15972Medicare UPIN
CA00AX61110Medicaid
020A61110OtherBLUE SHIELD ID #
F58572Medicare UPIN