Provider Demographics
NPI:1689762650
Name:VASSALLO, LINDA (CRNFA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MARBLE CANYON CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4829
Mailing Address - Country:US
Mailing Address - Phone:925-735-6392
Mailing Address - Fax:925-735-6392
Practice Address - Street 1:430 MARBLE CANYON CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4829
Practice Address - Country:US
Practice Address - Phone:925-735-6392
Practice Address - Fax:925-735-6392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239561163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17896OtherHILL PHYSICIANS
CAZZZ46151ZOtherBLUE SHIELD