Provider Demographics
NPI:1639401243
Name:LIN, ANDREW TA (LVN)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TA
Last Name:LIN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24005 PRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3847
Mailing Address - Country:US
Mailing Address - Phone:949-243-2555
Mailing Address - Fax:
Practice Address - Street 1:24005 PRAGUE ST
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3847
Practice Address - Country:US
Practice Address - Phone:949-243-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN171805164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse