Healthcare Provider Details

I. General information

NPI: 1992383087
Provider Name (Legal Business Name): ASHLEY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 N BELLFLOWER BLVD.
LONG BEACH CA
90815
US

IV. Provider business mailing address

2110 N BELLFLOWER BLVD.
LONG BEACH CA
90815
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-2222
  • Fax: 562-546-8210
Mailing address:
  • Phone: 562-346-2222
  • Fax: 562-546-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: