Individual
LINDA KOENIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8310 BAXTER WAY, RIVERSIDE, CA 92504-4302
(951) 689-9366
(951) 689-9366
Mailing address
8172 MAGNOLIA AVE, RIVERSIDE, CA 92504-3441
(951) 689-9366
(951) 352-7374
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
330015CN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33352
DRUG-MEDICAL
CA
Enumeration date
02/12/2008
Last updated
02/12/2008
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