MEDICARE: ANA LY M.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	ASW 30478	CA

General Provider Information

NPI Number	:	1386763498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LY M.S.W.

Provider Business Mailing Address
First Line	:	P.O. BOX 6193
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-1261
Country	:	US
Telephone Number	:	626-975-8743
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 N. OAKLAND AVE.
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1934
Country	:	US
Telephone Number	:	626-395-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	06/06/2013

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