Basic Information
| Provider Information | |||||||||
| NPI: | 1720577265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOTO | ||||||||
| FirstName: | EDLIRA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 54677 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900540677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184453700 | ||||||||
| FaxNumber: | 7184604051 | ||||||||
| Practice Location | |||||||||
| Address1: | 15806 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113581641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184453700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F341248-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 881256669 | 01 | NY | DRIVER LICENSE | OTHER |