Healthcare Provider Details

I. General information

NPI: 1376831875
Provider Name (Legal Business Name): SHIRLEY ANN STANLEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 30TH ST
LOS ANGELES CA
90007-3320
US

IV. Provider business mailing address

26806 STONEGATE DR
VALENCIA CA
91381-0659
US

V. Phone/Fax

Practice location:
  • Phone: 213-284-3200
  • Fax:
Mailing address:
  • Phone: 661-714-1108
  • Fax: 661-255-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number432344
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number432344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: