Provider Demographics
NPI:1881736155
Name:MAGNESS, LINDA MIESES (PA C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MIESES
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MELODEE
Other - Last Name:MIESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 19
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3628
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:900 VETERANS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1741
Practice Address - Country:US
Practice Address - Phone:650-298-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18784363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical