Healthcare Provider Details

I. General information

NPI: 1013524586
Provider Name (Legal Business Name): JOY LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 UNIVERSITY AVE APT 225
LA MESA CA
91942-6098
US

IV. Provider business mailing address

PO BOX 710513
SAN DIEGO CA
92171-0513
US

V. Phone/Fax

Practice location:
  • Phone: 858-395-8651
  • Fax:
Mailing address:
  • Phone: 858-395-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number832698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: