Provider Demographics
NPI:1174950323
Name:WORTHAM, LINDA MARIA (LVN)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIA
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8264 LARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2814
Mailing Address - Country:US
Mailing Address - Phone:858-874-4451
Mailing Address - Fax:
Practice Address - Street 1:8264 LARKDALE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2814
Practice Address - Country:US
Practice Address - Phone:858-874-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN259999164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse