MEDICARE: YASMEEN ALEXANDERIA ANDERSON-CANNON LVN

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	164X00000X	Licensed Vocational Nurse	718662	CA

General Provider Information

NPI Number	:	1720792484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMEEN ALEXANDERIA ANDERSON-CANNON LVN

Provider Business Mailing Address
First Line	:	125 W 4TH ST APT 807
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-1251
Country	:	US
Telephone Number	:	323-328-6648
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 W 4TH ST APT 807
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90013-1251
Country	:	US
Telephone Number	:	323-328-6648
Fax Number	:

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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