Provider Demographics
NPI:1790478154
Name:REIDY, LINDA MARGARITA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARGARITA
Last Name:REIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 CARDIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2556
Mailing Address - Country:US
Mailing Address - Phone:805-766-0549
Mailing Address - Fax:
Practice Address - Street 1:540 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4230
Practice Address - Country:US
Practice Address - Phone:805-879-0670
Practice Address - Fax:805-898-3611
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739170163WX0200X
CA9507288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology