Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP9369 | CA |
NPI | 1003964990 |
---|---|
Provider Name | Gloria S Tongson |
First Address | Panorama City, CA 91402-5423 |
Second Address | Panorama City, CA 91402-5423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 23/09/2008 |