Provider Demographics
NPI:1245799873
Name:SEON, ANISAH I
Entity Type:Individual
Prefix:MS
First Name:ANISAH
Middle Name:I
Last Name:SEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 DON TOMASO DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5325
Mailing Address - Country:US
Mailing Address - Phone:323-412-2329
Mailing Address - Fax:
Practice Address - Street 1:4043 DON TOMASO DR APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5325
Practice Address - Country:US
Practice Address - Phone:323-412-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694592164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse