Provider Demographics
NPI:1780691998
Name:HORNBOSTEL, LINDA K (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:K
Last Name:HORNBOSTEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 SACRAMENTO ST
Mailing Address - Street 2:#104
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1884
Mailing Address - Country:US
Mailing Address - Phone:415-775-0594
Mailing Address - Fax:415-681-9630
Practice Address - Street 1:3527 SACRAMENTO ST
Practice Address - Street 2:#104
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1884
Practice Address - Country:US
Practice Address - Phone:415-775-0594
Practice Address - Fax:415-681-9630
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11198103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PL11198Medicare UPIN