MEDICARE: MYLYNN NGO

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363LF0000X	Family Nurse Practitioner	5570	HI

General Provider Information

NPI Number	:	1649144031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLYNN NGO

Provider Business Mailing Address
First Line	:	3077 MARTIN AVE APT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-2553
Country	:	US
Telephone Number	:	252-288-1011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3077 MARTIN AVE APT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-2553
Country	:	US
Telephone Number	:	252-288-1011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	02/17/2026

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Directions to “ MYLYNN NGO ” Practice Location

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