Provider Demographics
NPI:1891347159
Name:TRA-NEVAREZ, LINDA THANH
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:THANH
Last Name:TRA-NEVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:THANH
Other - Last Name:TRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4858 CHARLOTTE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1314
Mailing Address - Country:US
Mailing Address - Phone:951-315-3367
Mailing Address - Fax:
Practice Address - Street 1:1405 SPRUCE ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2410
Practice Address - Country:US
Practice Address - Phone:951-715-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator