Healthcare Provider Details

I. General information

NPI: 1205996386
Provider Name (Legal Business Name): PATRICIA NATALIE ANDERSON FNP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

IV. Provider business mailing address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-7999
  • Fax:
Mailing address:
  • Phone: 562-867-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15411NP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number503339RN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: