Healthcare Provider Details

I. General information

NPI: 1639637945
Provider Name (Legal Business Name): JUNEFAITH CANGREJO ISMAGIL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3356 W BALL RD STE 100
ANAHEIM CA
92804-3727
US

IV. Provider business mailing address

9262 CAPE COD DR
HUNTINGTON BEACH CA
92646-3502
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-6625
  • Fax: 714-827-9726
Mailing address:
  • Phone: 714-362-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberNP95009494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: