Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95002238 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 693049 | CA |
NPI | 1013378967 |
---|---|
Provider Name | Mr. Anthony Ward JR. |
First Address | Los Angeles, CA 90017-1931 |
Second Address | Los Angeles, CA 90017-1908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 07/09/2017 |