Provider Demographics
NPI:1821587130
Name:WOLDEMARIAM, LINA TSEGAYE (NP)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:TSEGAYE
Last Name:WOLDEMARIAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3740 SANTA ROSALIA DR APT 406
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3625
Mailing Address - Country:US
Mailing Address - Phone:909-461-0338
Mailing Address - Fax:
Practice Address - Street 1:1703 TERMINO AVE STE 203
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2128
Practice Address - Country:US
Practice Address - Phone:562-961-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95008685363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health