MEDICARE: ASHLYNN FISS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC2000X	Children's Hospital

General Provider Information

NPI Number	:	1316308935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLYNN FISS

Provider Business Mailing Address
First Line	:	2150 S STATE COLLEGE BLVD
Second Line	:	APT. 1043
City	:	ANAHEIM
State	:	CA
Zip	:	92806-0102
Country	:	US
Telephone Number	:	818-326-0743
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 THE CITY DR S # ZC4482
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3201
Country	:	US
Telephone Number	:	714-456-7002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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