Healthcare Provider Details

I. General information

NPI: 1174631873
Provider Name (Legal Business Name): ANNE MARIE MOYLAN RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LOMITA BLVD #602
TORRANCE CA
90505
US

IV. Provider business mailing address

3400 LOMITA BLVD #602
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-326-5150
  • Fax: 310-326-0762
Mailing address:
  • Phone: 310-326-5150
  • Fax: 310-326-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRNP288982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: