| Doctor Name: | ANNIE A LY |
| NPI Number: | 1568629368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MFT INTERN |
| License Number: | |
| Business Practice Address: | 769 W Blaine St Suite 241 Riverside, CA - 925073970 |
| Business Phone Number: | 9513585196 |
| Business Fax Number: | |
| Mailing Address: | 769 W Blaine St, RIVERSIDE |
| State: | CA |
| Postal Code: | 925073970 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2008 |
| NPI Last Update Date: | 02/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |