Provider Demographics
NPI:1831295849
Name:SWASNON, LINDA LU (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LU
Last Name:SWASNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4708
Mailing Address - Country:US
Mailing Address - Phone:310-517-0931
Mailing Address - Fax:310-517-0934
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4708
Practice Address - Country:US
Practice Address - Phone:310-517-0931
Practice Address - Fax:310-517-0934
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE05472Medicare UPIN