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General NPI Number Information
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NPI Number | 1366008633
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Entity Type | Individual
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Provider Name | ANNESSA DU
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 11346 MOUNTAIN VIEW AVE STE B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3833
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Country | US
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Telephone | 909-796-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 7711 MELROSE AVE
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City | ROSEMEAD
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State | CA
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Zip | 91770-3075
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Country | US
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Telephone | 626-696-6961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34372
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License Number State | CA
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