Healthcare Provider Details

I. General information

NPI: 1205298494
Provider Name (Legal Business Name): MS. JOY EFANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W MANCHESTER BLVD UNIT 75
INGLEWOOD CA
90305-4075
US

IV. Provider business mailing address

3500 W MANCHESTER BLVD UNIT 75
INGLEWOOD CA
90305-4075
US

V. Phone/Fax

Practice location:
  • Phone: 310-672-1531
  • Fax:
Mailing address:
  • Phone: 310-672-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN410079
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95002956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: