Provider Demographics
NPI:1679617930
Name:POLGREEN, LYNDA E (MD)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:E
Last Name:POLGREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:E
Other - Last Name:OIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-8634
Mailing Address - Fax:855-246-2329
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-8634
Practice Address - Fax:855-246-2329
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC133183208000000X, 2080P0205X
MN474462080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty