Basic Information
Provider Information
NPI: 1528593159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINARES
FirstName: ANTHONY
MiddleName: JAMES
NamePrefix:  
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 300 UCLA MEDICAL PLZ STE B200
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900952004
CountryCode: US
TelephoneNumber: 3107941195
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2017
LastUpdateDate: 07/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 07/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2084N0400XA157815CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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