Provider Demographics
NPI: | 1639895741 |
---|---|
Name: | ALLO INTEGRATIVE HEALTH CENTER |
Entity Type: | Organization |
Organization Name: | ALLO INTEGRATIVE HEALTH CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | NURSE MIDWIFE, NURSE PRACTITIONER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHANELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NSANGOU NJOYA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DNP, FNP-C, CNM |
Authorized Official - Phone: | 562-600-0123 |
Mailing Address - Street 1: | 360 E 1ST ST # 2049 |
Mailing Address - Street 2: | |
Mailing Address - City: | TUSTIN |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92780-3211 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 562-600-0123 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 136 MONTE VIS |
Practice Address - Street 2: | |
Practice Address - City: | IRVINE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92602-2004 |
Practice Address - Country: | US |
Practice Address - Phone: | 562-600-0123 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-10-19 |
Last Update Date: | 2022-10-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |