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NPI Code Detail

MEDICARE: PHUONG LY NP

MEDICARE: PHUONG LY NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95006259CA

General Provider Information

NPI Number : 1174063366
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHUONG LY NP
Provider Business Mailing Address
First Line : 19121 BEACH BLVD
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 19121 BEACH BLVD
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2307
Country : US
Telephone Number : 714-848-1522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2017
Last Update Date : 03/09/2017

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Directions to “ PHUONG LY NP” Practice Location

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