Healthcare Provider Details

I. General information

NPI: 1326810409
Provider Name (Legal Business Name): ANN LY MSGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST STE 6220
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

6826 ELM AVE
SAN BERNARDINO CA
92404-5708
US

V. Phone/Fax

Practice location:
  • Phone: 909-651-1899
  • Fax: 909-651-1770
Mailing address:
  • Phone: 909-601-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: