Provider Demographics
NPI:1851350698
Name:LIN, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:LIN
Suffix:
Gender:M
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 1:6155 STONERIDGE DR 101
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3365
Mailing Address - Country:US
Mailing Address - Phone:925-251-9451
Mailing Address - Fax:925-251-0356
Practice Address - Street 1:6155 STONERIDGE DR
Practice Address - Street 2:STE 101
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3365
Practice Address - Country:US
Practice Address - Phone:925-251-9451
Practice Address - Fax:925-251-0356
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53538208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA233977Medicaid
CA943375280OtherFEDERAL TAX ID NUMBER
CA00A53538Medicaid
G77786Medicare UPIN