Provider Demographics
NPI:1730115155
Name:LINDA MAK, MD, INC.
Entity Type:Organization
Organization Name:LINDA MAK, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-353-0574
Mailing Address - Street 1:PO BOX 2678
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2678
Mailing Address - Country:US
Mailing Address - Phone:760-353-0574
Mailing Address - Fax:760-353-0397
Practice Address - Street 1:1745 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4243
Practice Address - Country:US
Practice Address - Phone:760-353-0574
Practice Address - Fax:760-353-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15903OtherMEDICARE PROVIDER