Provider Demographics
NPI:1184902900
Name:LE, DUY-PHUONG LOC (FNP)
Entity type:Individual
Prefix:
First Name:DUY-PHUONG
Middle Name:LOC
Last Name:LE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:LOC
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-400-0701
Mailing Address - Fax:
Practice Address - Street 1:5406 SUNRISE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610
Practice Address - Country:US
Practice Address - Phone:800-972-5547
Practice Address - Fax:916-887-7963
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20762363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily