Healthcare Provider Details

I. General information

NPI: 1376821405
Provider Name (Legal Business Name): JOE ANDREWS ONG NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOANN URNOS ONG

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 64-128 CHS
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

10833 LE CONTE AVE 64-128 CHS
LOS ANGELES CA
90095-3075
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7333
  • Fax: 310-794-7335
Mailing address:
  • Phone: 310-794-7333
  • Fax: 310-794-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP20499
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberCNS3570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: