Provider Demographics
NPI:1023136777
Name:PANCHO, LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:PANCHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10796
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-0796
Mailing Address - Country:US
Mailing Address - Phone:916-440-7569
Mailing Address - Fax:916-440-7621
Practice Address - Street 1:1500 CAPITOL AVE # MS -2303
Practice Address - Street 2:SUITE 72.420
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5006
Practice Address - Country:US
Practice Address - Phone:916-440-7569
Practice Address - Fax:916-440-7621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40000173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine