Provider Demographics
NPI:1689984965
Name:E. MICHAEL LINZEY,M.D.,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:E. MICHAEL LINZEY,M.D.,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LINZEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-8715
Mailing Address - Street 1:1140 W. LA VETA AVE. #770
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-8715
Mailing Address - Fax:714-835-3960
Practice Address - Street 1:1140 W LA VETA AVE STE 770
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4229
Practice Address - Country:US
Practice Address - Phone:714-835-8715
Practice Address - Fax:714-835-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25389OtherMEDICARE PTAN
CA00A253890OtherMEDI-CAL
CA1285722058OtherNPI SOLE PROVIDER NUMBER