Healthcare Provider Details

I. General information

NPI: 1326370719
Provider Name (Legal Business Name): ANN MARY BILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 300
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

3701 VISTA DE ORA
LOS ALAMITOS CA
90720-4140
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2869
  • Fax:
Mailing address:
  • Phone: 562-431-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number530873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: