Provider Demographics
NPI:1609510130
Name:OO, CHOMYA (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHOMYA
Middle Name:
Last Name:OO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3782
Mailing Address - Country:US
Mailing Address - Phone:909-946-4222
Mailing Address - Fax:909-946-8243
Practice Address - Street 1:41990 COOK ST BLDG F-2002
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6100
Practice Address - Country:US
Practice Address - Phone:760-674-7132
Practice Address - Fax:760-674-7120
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020380363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health