Healthcare Provider Details

I. General information

NPI: 1376850883
Provider Name (Legal Business Name): JOCELYN POGUE KON ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN POGUE ACNP

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA DEPARTMENT OF LIVER TRANSPLANT SURGERY 757 WESTWOOD PLAZA 8501
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8138
  • Fax: 310-794-3344
Mailing address:
  • Phone: 310-825-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number688796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: