Healthcare Provider Details

I. General information

NPI: 1265732507
Provider Name (Legal Business Name): JOYCE CHOWSANITPHON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

1500 DUARTE RD
DUARTE CA
91010-3012
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-4673
  • Fax:
Mailing address:
  • Phone: 626-256-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3465
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: