Basic Information
Provider Information
NPI: 1184618175
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINSON
FirstName: PATRICK
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10170 SORRENTO VALLEY RD
Address2: MAIL DROP SV-5
City: SAN DIEGO
State: CA
PostalCode: 921211604
CountryCode: US
TelephoneNumber: 8587845888
FaxNumber:  
Practice Location
Address1: 916 SYCAMORE AVE
Address2: SUITE 100
City: VISTA
State: CA
PostalCode: 920817815
CountryCode: US
TelephoneNumber: 7605999545
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2005
LastUpdateDate: 07/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XA83054CAY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

ID Information
IDTypeStateIssuerDescription
00A83054005CA MEDICAID


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