Healthcare Provider Details

I. General information

NPI: 1982802336
Provider Name (Legal Business Name): HODA M. SHAWKY RN, PHN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

IV. Provider business mailing address

1590D ROSECRANS AVE # 164
MANHATTAN BEACH CA
90266-3707
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax:
Mailing address:
  • Phone: 310-725-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number15859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: