MEDICARE: MRS. CHRISTINE JOY PHONGDARA N.P.

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	363LW0102X	Women's Health Nurse Practitioner	504575	CA

General Provider Information

NPI Number	:	1659589489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE JOY PHONGDARA N.P.

Provider Business Mailing Address
First Line	:	8812 E CRESTVIEW LN
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808-1663
Country	:	US
Telephone Number	:	714-281-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	4990 ARLINGTON AVE STE D
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2757
Country	:	US
Telephone Number	:	951-785-9011
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/12/2019

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