Provider Demographics
NPI:1265149207
Name:CONTRERAS, LINEIDYS (PA-C)
Entity type:Individual
Prefix:
First Name:LINEIDYS
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINEIDYS
Other - Middle Name:
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:587 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-5115
Mailing Address - Country:US
Mailing Address - Phone:619-844-9597
Mailing Address - Fax:
Practice Address - Street 1:587 TREMONT ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-5115
Practice Address - Country:US
Practice Address - Phone:619-844-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA9096363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant