Healthcare Provider Details

I. General information

NPI: 1972734929
Provider Name (Legal Business Name): JULIE ANN CANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S RAYMOND AVE
PASADENA CA
91105-3229
US

IV. Provider business mailing address

PO BOX 90730
PASADENA CA
91109-0730
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8051
  • Fax: 626-795-0356
Mailing address:
  • Phone: 626-795-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: