Provider Demographics
NPI:1912187048
Name:MARISCAL, LINDA MARIA (RN, PHN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIA
Last Name:MARISCAL
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:MARISCAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:899 NORTHGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3636
Mailing Address - Country:US
Mailing Address - Phone:415-473-6008
Mailing Address - Fax:415-473-6881
Practice Address - Street 1:899 NORTHGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3636
Practice Address - Country:US
Practice Address - Phone:415-473-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN352612163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management