1417108069 NPI number — ALMIRA WILSON CANN MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417108069 NPI number — ALMIRA WILSON CANN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALMIRA WILSON CANN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417108069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50033
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91115-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-405-0444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1070 E GREEN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-405-0444
Provider Business Practice Location Address Fax Number:
626-405-0641
Provider Enumeration Date:
10/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CANN
Authorized Official First Name:
ALMIRA
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
OWNER AND CEO
Authorized Official Telephone Number:
626-405-0444

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G49269 , 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)





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