Provider Demographics
NPI:1710030747
Name:FALCONIO MD, LINDA S (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:FALCONIO MD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:161 THUNDER DR STE. 102
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-631-4000
Mailing Address - Fax:760-631-4008
Practice Address - Street 1:161 THUNDER DR #102
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:760-631-4000
Practice Address - Fax:760-631-4008
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37851207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37851OtherSTATE LICENSE
CA00G378510Medicaid
CA00G378510Medicaid
CAG37851OtherSTATE LICENSE