Provider Demographics
NPI:1881890713
Name:LINDWALL, ELVIRA ALEXANDROVNA (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:ALEXANDROVNA
Last Name:LINDWALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2230 LYNN RD STE 330
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1989
Mailing Address - Country:US
Mailing Address - Phone:805-370-1965
Mailing Address - Fax:805-370-1984
Practice Address - Street 1:2230 LYNN RD STE 330
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1989
Practice Address - Country:US
Practice Address - Phone:805-370-1965
Practice Address - Fax:805-370-1984
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA120355207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG1051ZMedicare UPIN