Provider Demographics
NPI:1144544412
Name:LINDI H. VANDERWALDE, MD INC.
Entity type:Organization
Organization Name:LINDI H. VANDERWALDE, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDI
Authorized Official - Middle Name:H
Authorized Official - Last Name:VANDERWALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-421-8225
Mailing Address - Street 1:1880 CENTURY PARK E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1600
Mailing Address - Country:US
Mailing Address - Phone:310-289-9333
Mailing Address - Fax:310-552-1626
Practice Address - Street 1:8900 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1958
Practice Address - Country:US
Practice Address - Phone:310-432-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94946208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty