Provider Demographics
NPI:1295437788
Name:HADDAD, ANNALYN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANNALYN
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROYAL WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6798
Mailing Address - Country:US
Mailing Address - Phone:909-905-8141
Mailing Address - Fax:
Practice Address - Street 1:757 N COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3944
Practice Address - Country:US
Practice Address - Phone:909-621-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse