Healthcare Provider Details

I. General information

NPI: 1568979417
Provider Name (Legal Business Name): REX FRANCIS TJOA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2018
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 340
LONG BEACH CA
90808-1793
US

IV. Provider business mailing address

3828 SCHAUFELE AVE STE 340
LONG BEACH CA
90808-1793
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-9052
  • Fax:
Mailing address:
  • Phone: 657-241-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95007349
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95007349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: