Individual
AN LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1510 SAN PABLO ST, LOS ANGELES, CA 90033-5320
(626) 457-6601
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(626) 457-6601
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/04/2023
Last updated
10/27/2024
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