Healthcare Provider Details

I. General information

NPI: 1881729697
Provider Name (Legal Business Name): OUAYPORN SAKOOLPAILOH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEAH SAKOOLPAILOH NP

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST LOMA LINDA UNIVERSITY MEDICAL CENTER - APN DEPARTMENT
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON STREET (APN OFFICE)
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4341
  • Fax: 909-558-0100
Mailing address:
  • Phone: 909-558-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number504373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: