Provider Demographics
NPI:1417442740
Name:DAVID, LYDIA JOY (MAED, MSN, FNP, RN)
Entity Type:Individual
Prefix:
First Name:LYDIA JOY
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:MAED, MSN, FNP, RN
Other - Prefix:
Other - First Name:LYDIA JOY
Other - Middle Name:TUAZON-WONG
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAED, MSN, FNP, RN
Mailing Address - Street 1:1769 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4513
Mailing Address - Country:US
Mailing Address - Phone:626-922-6011
Mailing Address - Fax:
Practice Address - Street 1:1769 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-922-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily