Healthcare Provider Details

I. General information

NPI: 1194161554
Provider Name (Legal Business Name): MICHELL ANN CADIZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE NOR 3470
LOS ANGELES CA
90089-0112
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-3742
  • Fax: 323-865-0873
Mailing address:
  • Phone: 323-865-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: