Provider Demographics
NPI:1578635397
Name:DEGUSTA, LINDA CATHERINE POLLACK (MD)
Entity type:Individual
Prefix:
First Name:LINDA CATHERINE
Middle Name:POLLACK
Last Name:DEGUSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA CATHERINE
Other - Middle Name:POLLACK
Other - Last Name:DEGUSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:510-454-1000
Mailing Address - Fax:
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A664100Medicaid
CA00A664100Medicaid
00A664100Medicare ID - Type Unspecified