Basic Information
| Provider Information | |||||||||
| NPI: | 1043868276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYER | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7232 CANBY AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913358143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187055561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7232 CANBY AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913358143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1887055561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2019 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 137484 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.