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General NPI Number Information
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NPI Number | 1437262219
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Entity Type | Individual
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Provider Name | ANA JULIA POPOCA-LOGUE N.P.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 2650 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3439
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Country | US
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Telephone | 626-577-2261
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Fax | 626-577-2543
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Provider Business Mailing Address
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Address Line | 5121 BAXTER ST
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City | SAN DIEGO
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State | CA
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Zip | 92117-1302
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Country | US
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Telephone | 858-922-9991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 524129
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12900
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License Number State | CA
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