Healthcare Provider Details

I. General information

NPI: 1386763498
Provider Name (Legal Business Name): ANA LY M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 N. OAKLAND AVE.
PASADENA CA
91104-1934
US

IV. Provider business mailing address

P.O. BOX 6193
ROSEMEAD CA
91770-1261
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-975-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 30478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: