Healthcare Provider Details

I. General information

NPI: 1386705903
Provider Name (Legal Business Name): ANN T IGAWA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 W RIVERSIDE DR
BURBANK CA
91505-4044
US

IV. Provider business mailing address

23388 MULHOLLAND DR
WOODLAND HILLS CA
91364-2733
US

V. Phone/Fax

Practice location:
  • Phone: 818-556-2700
  • Fax: 818-295-3395
Mailing address:
  • Phone: 818-876-1636
  • Fax: 818-295-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP3569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: