Healthcare Provider Details

I. General information

NPI: 1558119990
Provider Name (Legal Business Name): ANNE SY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 STUDEBAKER RD
NORWALK CA
90650-2531
US

IV. Provider business mailing address

7725 GATEWAY UNIT 2209
IRVINE CA
92618-5817
US

V. Phone/Fax

Practice location:
  • Phone: 855-464-2234
  • Fax:
Mailing address:
  • Phone: 657-243-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95162164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: