Provider Demographics
NPI:1770172215
Name:VASCONCELLOS, LINDA LEE (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:VASCONCELLOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 RED FERN CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2602
Mailing Address - Country:US
Mailing Address - Phone:858-353-0498
Mailing Address - Fax:
Practice Address - Street 1:10140 CAMPUS POINT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1520
Practice Address - Country:US
Practice Address - Phone:858-435-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375522163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn