Healthcare Provider Details

I. General information

NPI: 1821958992
Provider Name (Legal Business Name): MITHONA DEE LOEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MITHONA DEE LOEUNG-AGAPITOS

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14516 BORA DR
LA MIRADA CA
90638-3740
US

IV. Provider business mailing address

14516 BORA DR
LA MIRADA CA
90638-3740
US

V. Phone/Fax

Practice location:
  • Phone: 562-485-8116
  • Fax:
Mailing address:
  • Phone: 562-485-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: