Healthcare Provider Details

I. General information

NPI: 1710401229
Provider Name (Legal Business Name): CINDY HASLAM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W 7TH ST
LOS ANGELES CA
90057-4002
US

IV. Provider business mailing address

3657 E 4TH ST
LOS ANGELES CA
90063-3916
US

V. Phone/Fax

Practice location:
  • Phone: 213-384-3434
  • Fax:
Mailing address:
  • Phone: 323-453-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number95063355
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: