Provider Demographics
NPI:1871664987
Name:DAVIS, LINDA MARLENE BOLLING (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARLENE BOLLING
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:MARLENE
Other - Last Name:BOLLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25982 PALA
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6719
Mailing Address - Country:US
Mailing Address - Phone:949-600-8990
Mailing Address - Fax:949-600-8998
Practice Address - Street 1:25982 PALA
Practice Address - Street 2:SUITE 180
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6719
Practice Address - Country:US
Practice Address - Phone:949-600-8990
Practice Address - Fax:949-600-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine