Healthcare Provider Details

I. General information

NPI: 1992464572
Provider Name (Legal Business Name): MARIA FRANCESCA LARISSA ANSELMO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCESCA ANSELMO

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 600
SANTA MONICA CA
90404-2131
US

IV. Provider business mailing address

12629 RIVERSIDE DR APT 252
VALLEY VILLAGE CA
91607-3482
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95018572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: