1376898494 NPI number — EMILY LANCASTER TAJUDEEN ANP-C

Table of content: LISA MARIE CANO P.A. (NPI 1619912276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376898494 NPI number — EMILY LANCASTER TAJUDEEN ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAJUDEEN
Provider First Name:
EMILY
Provider Middle Name:
LANCASTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANCASTER
Provider Other First Name:
EMILY
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376898494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 W CORNELIA AVE
Provider Second Line Business Mailing Address:
1N
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-625-0319
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6043 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-337-1720
Provider Business Practice Location Address Fax Number:
323-337-1784
Provider Enumeration Date:
07/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  22019 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22019 . This is a "CALIFORNIA FURNISHING LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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