Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | NP95009689 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | NP95009689 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | NP95009689 | CA |
NPI | 1033765474 |
---|---|
Provider Name | Mary Elaine Constantino Aguilar-Choomngern |
First Address | Lakewood, CA 90712-1467 |
Second Address | Long Beach, CA 90806-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |