Provider Demographics
NPI:1710030747
Name:FALCONIO, LINDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:FALCONIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:STE 130
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-631-4000
Mailing Address - Fax:760-631-4008
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:STE 130
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-631-4000
Practice Address - Fax:760-631-4008
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378510Medicaid
CAG37851OtherSTATE LICENSE
CA00G378510Medicaid
CAG37851OtherSTATE LICENSE