Provider Demographics
NPI:1679506349
Name:LINATOC, MARILOU (NP)
Entity Type:Individual
Prefix:
First Name:MARILOU
Middle Name:
Last Name:LINATOC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-508-3458
Mailing Address - Fax:505-433-2475
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-508-3458
Practice Address - Fax:505-433-2475
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209000432363L00000X
NMCNP01894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78071241Medicaid
NM78071241Medicaid