Provider Demographics
NPI:1659589489
Name:PHONGDARA, CHRISTINE JOY (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JOY
Last Name:PHONGDARA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8812 E CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1663
Mailing Address - Country:US
Mailing Address - Phone:714-281-2534
Mailing Address - Fax:
Practice Address - Street 1:4990 ARLINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2757
Practice Address - Country:US
Practice Address - Phone:951-785-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504575363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health