Provider Demographics
NPI:1326810409
Name:LY, ANN (MSGC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:MSGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5708
Mailing Address - Country:US
Mailing Address - Phone:909-601-5513
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST STE 6220
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-651-1899
Practice Address - Fax:909-651-1770
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001758170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS