Active NPI
Cornelius Van Der Linde
- Pharmacist
- Indio, CA
National Provider Identifier
1083028336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 53983
- Practice address
- 45527 Meadow Lake Dr
Indio, CA 92201-4998 - Phone
- (760) 285-1249
- NPI assigned
- Jun 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 53983 | CA | Primary |
Addresses
Primary practice location
45527 Meadow Lake Dr
Indio, CA 92201-4998
Mailing address
45527 Meadow Lake Dr
Indio, CA 92201-4998
Phone (760) 285-1249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53983 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402790400000",
"number": "1083028336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45527 MEADOW LAKE DR",
"city": "INDIO",
"state": "CA",
"postal_code": "922014998",
"telephone_number": "760-285-1249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45527 MEADOW LAKE DR",
"city": "INDIO",
"state": "CA",
"postal_code": "922014998",
"telephone_number": "760-285-1249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DER LINDE",
"first_name": "CORNELIUS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-15",
"last_updated": "2014-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "53983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.