Healthcare Provider Details

I. General information

NPI: 1972309730
Provider Name (Legal Business Name): AILEEN SON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR
DURHAM NC
27710-3038
US

IV. Provider business mailing address

307 TRENT DR
DURHAM NC
27710-3038
US

V. Phone/Fax

Practice location:
  • Phone: 510-299-7477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95344068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: