MEDICARE: MAKSUDA YASMIN ISLAM

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	363LF0000X	Family Nurse Practitioner	95036582	CA

General Provider Information

NPI Number	:	1548106206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKSUDA YASMIN ISLAM

Provider Business Mailing Address
First Line	:	1479 S CARNELIAN ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2100
Country	:	US
Telephone Number	:	323-778-8485
Fax Number	:	323-778-4452

Provider Business Practice Location Address
First Line	:	1704 W MANCHESTER AVE STE 109
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3056
Country	:	US
Telephone Number	:	323-778-8485
Fax Number	:	323-778-4452

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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