Healthcare Provider Details

I. General information

NPI: 1164177077
Provider Name (Legal Business Name): JOYCELYN TIONG LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8353 WIND FLOWER WAY
ANTELOPE CA
95843-4026
US

IV. Provider business mailing address

8353 WIND FLOWER WAY
ANTELOPE CA
95843-4026
US

V. Phone/Fax

Practice location:
  • Phone: 916-640-4915
  • Fax:
Mailing address:
  • Phone: 916-640-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number703354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number104561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: