Healthcare Provider Details

I. General information

NPI: 1740885813
Provider Name (Legal Business Name): ANN PATY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

IV. Provider business mailing address

4335 ATLANTIC AVE
LONG BEACH CA
90807-2803
US

V. Phone/Fax

Practice location:
  • Phone: 562-216-4900
  • Fax:
Mailing address:
  • Phone: 562-216-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: