Healthcare Provider Details

I. General information

NPI: 1114782398
Provider Name (Legal Business Name): ERWIN SAMPANG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LYONWOOD AVE
WALNUT CA
91789-3312
US

IV. Provider business mailing address

731 LYONWOOD AVE
WALNUT CA
91789-3312
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-5744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017580
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: