=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568831220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MCCAMMON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2015
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13210 FLORENCE AVE # 19
-----------------------------------------------------
City | SANTA FE SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90670-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-574-2637
-----------------------------------------------------
Fax | 213-533-1066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8950 SERAPIS AVE APT 19
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90240-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-980-4891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 95159983
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 697866
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------