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General NPI Number Information
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NPI Number | 1922586437
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Entity Type | Individual
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Provider Name | EVONNE HOA PHAN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 18433 ROSCOE BLVD STE 106
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4129
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Country | US
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Telephone | 818-435-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 18000 STUDEBAKER RD STE 800
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City | CERRITOS
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State | CA
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Zip | 90703-2671
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Country | US
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Telephone | 562-735-3226
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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 | 95009102
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License Number State | CA
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