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General NPI Number Information
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NPI Number | 1497261614
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Entity Type | Individual
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Provider Name | LY THANH DUONG NP
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Gender | Female
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 3660 PARK SIERRA DR
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City | RIVERSIDE
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State | CA
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Zip | 92505-3081
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Country | US
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Telephone | 951-637-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 855 E HOSPITALITY LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3596
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Country | US
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Telephone | 909-885-0282
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95007415
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95007415
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License Number State | CA
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