Healthcare Provider Details

I. General information

NPI: 1821342924
Provider Name (Legal Business Name): LOIS JIN-A CHO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28780 SINGLE OAK DR STE 160
TEMECULA CA
92590-5528
US

IV. Provider business mailing address

28780 SINGLE OAK DR STE 160
TEMECULA CA
92590-5528
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-4193
  • Fax:
Mailing address:
  • Phone: 951-676-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201403455NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21883
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number201403455NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number21883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: