Provider Demographics
NPI:1801990312
Name:CANNADY, LILLIAN MAE (MEDICAL ASSISTANCE)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:MAE
Last Name:CANNADY
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 LINCOLN AVE
Mailing Address - Street 2:F
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4613
Mailing Address - Country:US
Mailing Address - Phone:714-761-4831
Mailing Address - Fax:714-761-4833
Practice Address - Street 1:7151 LINCOLN AVE
Practice Address - Street 2:F
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4613
Practice Address - Country:US
Practice Address - Phone:714-761-4831
Practice Address - Fax:714-761-4833
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45281332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies