Healthcare Provider Details

I. General information

NPI: 1508457375
Provider Name (Legal Business Name): IZHR GOCONG LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91607-3717
US

IV. Provider business mailing address

4838 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91607-3717
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-4455
  • Fax:
Mailing address:
  • Phone: 818-506-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number202474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: