Provider Demographics
NPI:1881729697
Name:SAKOOLPAILOH, OUAYPORN (NP)
Entity type:Individual
Prefix:
First Name:OUAYPORN
Middle Name:
Last Name:SAKOOLPAILOH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:SAKOOLPAILOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:11234 ANDERSON STREET
Mailing Address - Street 2:(APN OFFICE)
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-4341
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:LOMA LINDA UNIVERSITY MEDICAL CENTER - APN DEPARTMENT
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4341
Practice Address - Fax:909-558-0100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA504373OtherREGISTERED NURSE LICENSE