Healthcare Provider Details

I. General information

NPI: 1700568979
Provider Name (Legal Business Name): MYLOAN HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 S RIVERPOINT PKWY
PHOENIX AZ
85040-0723
US

IV. Provider business mailing address

4035 S RIVERPOINT PKWY
PHOENIX AZ
85040-0723
US

V. Phone/Fax

Practice location:
  • Phone: 844-937-8679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95257845
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: