Provider Demographics
NPI:1205298494
Name:EFANGA, JOY
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:
Last Name:EFANGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W MANCHESTER BLVD UNIT 75
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-4075
Mailing Address - Country:US
Mailing Address - Phone:310-672-1531
Mailing Address - Fax:
Practice Address - Street 1:3500 W MANCHESTER BLVD UNIT 75
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-4075
Practice Address - Country:US
Practice Address - Phone:310-672-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN410079163WM0705X
CANP95002956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical