Provider Demographics
NPI:1457057804
Name:TOMASSO, LINDA C
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:TOMASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CONCOURS STE 4102
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-6564
Mailing Address - Country:US
Mailing Address - Phone:909-240-1764
Mailing Address - Fax:
Practice Address - Street 1:1918 BUSINESS CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3439
Practice Address - Country:US
Practice Address - Phone:909-430-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician