Provider Demographics
NPI:1801909577
Name:LINDBERG, PAUL (CP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 BENTON ST./121
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-422-3178
Practice Address - Street 1:11201 BENTON ST./121
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-422-3178
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist