Provider Demographics
NPI:1699748392
Name:CANN, ALMIRA WILSON (MD)
Entity type:Individual
Prefix:DR
First Name:ALMIRA
Middle Name:WILSON
Last Name:CANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50033
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 E GREEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2432
Practice Address - Country:US
Practice Address - Phone:626-405-0444
Practice Address - Fax:626-405-0641
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G492690Medicaid
CA00G492690Medicaid
CAG49269Medicare ID - Type Unspecified