Provider Demographics
NPI:1821295825
Name:BENTLEY, LINDA
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:BENTLEY
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 1:2911 SOUTH 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8000
Mailing Address - Country:US
Mailing Address - Phone:928-783-3050
Mailing Address - Fax:928-539-0025
Practice Address - Street 1:2911 SOUTH 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8000
Practice Address - Country:US
Practice Address - Phone:928-783-3050
Practice Address - Fax:928-539-0025
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN120671207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ963381Medicaid