Basic Information
Provider Information
NPI: 1083122659
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRO
FirstName: SEUNG HEI ANNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NURSE PRACTITIONER
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 18316 VICKIE AVE
Address2:  
City: CERRITOS
State: CA
PostalCode: 907036165
CountryCode: US
TelephoneNumber: 5627562426
FaxNumber:  
Practice Location
Address1: 4445 MAGNOLIA AVE
Address2:  
City: RIVERSIDE
State: CA
PostalCode: 925014135
CountryCode: US
TelephoneNumber: 9517883000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/17/2018
LastUpdateDate: 01/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X95007064CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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