Healthcare Provider Details

I. General information

NPI: 1871255240
Provider Name (Legal Business Name): MACY DUONG MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8569
  • Fax:
Mailing address:
  • Phone: 310-829-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95103494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number95103494
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018747
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95018747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: