Healthcare Provider Details

I. General information

NPI: 1568831220
Provider Name (Legal Business Name): ELIZABETH MCCAMMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH FEDIGAN

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 FLORENCE AVE # 19
SANTA FE SPRINGS CA
90670-4510
US

IV. Provider business mailing address

8950 SERAPIS AVE APT 19
DOWNEY CA
90240-2600
US

V. Phone/Fax

Practice location:
  • Phone: 562-574-2637
  • Fax: 213-533-1066
Mailing address:
  • Phone: 914-980-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number697866
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95159983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: