Healthcare Provider Details

I. General information

NPI: 1447795182
Provider Name (Legal Business Name): ANN ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

1750 DATE AVE
TORRANCE CA
90503-7210
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4111
  • Fax: 562-984-5461
Mailing address:
  • Phone: 310-755-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005144
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95005144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: