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NPI Code Detail

MEDICARE: ANTHONY J GANN RN

MEDICARE: ANTHONY J GANN RN
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
1163W00000XRegistered Nurse95091739CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B3382459OTHERCACALIFORNIA DRIVERS LICENSE

General Provider Information

NPI Number : 1407326119
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY J GANN RN
Provider Business Mailing Address
First Line : 173 SANTA ANA AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-3461
Country : US
Telephone Number : 714-657-0687
Fax Number :
Provider Business Practice Location Address
First Line : 173 SANTA ANA AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-3461
Country : US
Telephone Number : 714-657-0687
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 11/26/2018

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