Provider Demographics
NPI:1659797322
Name:AYSON, JOSEPHINE ANG (LVN)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ANG
Last Name:AYSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1902
Mailing Address - Country:US
Mailing Address - Phone:408-250-2676
Mailing Address - Fax:408-727-7152
Practice Address - Street 1:711 CLYDE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1902
Practice Address - Country:US
Practice Address - Phone:408-250-2676
Practice Address - Fax:408-727-7152
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244665164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA244665OtherLVN LICENSE