Healthcare Provider Details

I. General information

NPI: 1669298766
Provider Name (Legal Business Name): BRIANNA WOO N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

6935 ALDERWOOD AVE
BUENA PARK CA
90621-1173
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax:
Mailing address:
  • Phone: 714-600-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: