Healthcare Provider Details

I. General information

NPI: 1548106206
Provider Name (Legal Business Name): MAKSUDA YASMIN ISLAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W MANCHESTER AVE STE 109
LOS ANGELES CA
90047-3056
US

IV. Provider business mailing address

1479 S CARNELIAN ST
ANAHEIM CA
92802-2100
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-8485
  • Fax: 323-778-4452
Mailing address:
  • Phone: 323-778-8485
  • Fax: 323-778-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: