Healthcare Provider Details

I. General information

NPI: 1285763763
Provider Name (Legal Business Name): PATRICIA KANNAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

IV. Provider business mailing address

3604 ASH ST
LAKE ELSINORE CA
92530-1874
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-8672
  • Fax:
Mailing address:
  • Phone: 951-674-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number264863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: