Healthcare Provider Details

I. General information

NPI: 1467633602
Provider Name (Legal Business Name): LYDA SAEEDY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 N VERMONT AVE
LOS ANGELES CA
90029-3529
US

IV. Provider business mailing address

1301 S GLENDORA AVE
GLENDORA CA
91740-5140
US

V. Phone/Fax

Practice location:
  • Phone: 323-666-6004
  • Fax:
Mailing address:
  • Phone: 626-914-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP6312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: