Healthcare Provider Details

I. General information

NPI: 1003255779
Provider Name (Legal Business Name): EUNICE N BISONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EUNICE B NKONGHO NP

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

IV. Provider business mailing address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax:
Mailing address:
  • Phone: 310-221-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22966
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN22966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: