Provider Demographics
NPI:1669515664
Name:MCDONALD, LINDA LOU
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:MCDONALD
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 1:56020 SANTA FE TRL
Mailing Address - Street 2:#M
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3148
Mailing Address - Country:US
Mailing Address - Phone:760-369-4057
Mailing Address - Fax:760-369-9473
Practice Address - Street 1:56020 SANTA FE TRL
Practice Address - Street 2:#M
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3148
Practice Address - Country:US
Practice Address - Phone:760-369-4057
Practice Address - Fax:760-369-9473
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner