Healthcare Provider Details

I. General information

NPI: 1891861324
Provider Name (Legal Business Name): JOAN HUGHES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT
LOS ANGELES CA
90020
US

IV. Provider business mailing address

2640 INDUSTRY WAY
LYNWOOD CA
90262-4284
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-2944
  • Fax:
Mailing address:
  • Phone: 310-627-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number499219
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016741
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number499219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: