Healthcare Provider Details

I. General information

NPI: 1376140715
Provider Name (Legal Business Name): CLARA HWANG MAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10711 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2312
US

IV. Provider business mailing address

12950 RIMROCK AVE
CHINO HILLS CA
91709-1031
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015454
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95081776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: