Provider Demographics
NPI:1811375488
Name:LINCOLN DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:LINCOLN DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-384-3216
Mailing Address - Street 1:151 KALMUS DR
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5988
Mailing Address - Country:US
Mailing Address - Phone:714-384-3216
Mailing Address - Fax:714-388-3802
Practice Address - Street 1:1775 E LINCOLN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4366
Practice Address - Country:US
Practice Address - Phone:714-384-3216
Practice Address - Fax:714-388-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty