Healthcare Provider Details

I. General information

NPI: 1558083121
Provider Name (Legal Business Name): MARVIN HOANG PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 MAYDEE ST
DUARTE CA
91010-3126
US

IV. Provider business mailing address

534 MAYDEE ST
DUARTE CA
91010-3126
US

V. Phone/Fax

Practice location:
  • Phone: 940-447-1299
  • Fax:
Mailing address:
  • Phone: 940-447-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: