Healthcare Provider Details

I. General information

NPI: 1568105898
Provider Name (Legal Business Name): EVE A NG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMPONKEIT NEAMTHRAPYA

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E 1ST ST STE 100
SANTA ANA CA
92705-4086
US

IV. Provider business mailing address

4 RANA
IRVINE CA
92612-2613
US

V. Phone/Fax

Practice location:
  • Phone: 714-556-7246
  • Fax:
Mailing address:
  • Phone: 562-387-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019593
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number95019593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: