PHONMANY PHENGPHAVONG (NPI# 1043849847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043849847 |
| Entity Type | Individual |
| Full Name | PHONMANY PHENGPHAVONG |
| Practice Address |
1688 N Perris Blvd Perris CA 92571-4709 |
| Mailing Address |
2982 Bautista St Riverside CA 92506-4293 |
| Practice Telephone | 9514432200 |
| Mailing Telephone | 9512242620 |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-03 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164X00000X | Licensed Vocational Nurse | 287603 | CA | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | OTHER | 05 |
| Street Address |
1688 N PERRIS BLVD |
| City | PERRIS |
| State | CA |
| Zip Code | 92571-4709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689785651 | Charolette A Barnes-leblanc | Optometrist | 1688 N Perris Blvd, Ste L5, Perris, CA 92571-4709 | 2006-08-31 |
| 1265945323 | Dalbir Kaur | Pharmacist | 1688 N Perris Blvd, Perris, CA 92571-4709 | 2017-11-13 |
| 1700328929 | Riverside County Mental Health Dept. | Counselor | 1688 N Perris Blvd, Suite L6-11, Perris, CA 92571 | 2016-11-07 |
| 1528429735 | Elizabeth Chon | Case Manager/Care Coordinator | 1688 N Perris Blvd, L 6-11, Perris, CA 92571-4709 | 2016-03-15 |
| 1548642150 | Brenda Preston | Counselor | 1688 N Perris Blvd, Suite L1-2, Perris, CA 92571-4709 | 2015-06-19 |
| 1861895088 | Jeremy Jin-ho Choi | Dentist | 1688 N Perris Blvd, Ste. G-1, Perris, CA 92571-4709 | 2014-10-01 |
| 1851791842 | Julie Casillas | Case Manager/Care Coordinator | 1688 N Perris Blvd, Ste L 6-11, Perris, CA 92571-4709 | 2014-08-27 |
| 1942614243 | Shawill Tadres | Pharmacist | 1688 N Perris Blvd, Perris, CA 92571-4709 | 2014-06-13 |
| 1417360611 | Riteaid | Pharmacist | 1688 N Perris Blvd, Perris, CA 92571-4709 | 2014-06-05 |
| 1790100188 | Adriana Romero Stivers | Case Manager/Care Coordinator | 1688 N Perris Blvd, Suite L6-11, Perris, CA 92571-4709 | 2014-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376199422 | Pico De Loro, Incorporated | Assisted Living Facility | 620 North Perris Boulevard, Perris, CA 92571 | 2019-08-14 |
| 1053802579 | Kadiatou Dafney | Nurse Practitioner | 126 Avocado Ave Ste 106, Perris, CA 92571 | 2018-05-21 |
| 1730677014 | Ruth Gasselle Rodriguez | Nutritionist | 1020 Huntington Way, Perris, CA 92571 | 2018-04-23 |
| 1649788167 | Leslie Bautista | Counselor | 1276 Autumnwood Ln, Perris, CA 92571 | 2018-01-18 |
| 1588180459 | Eduardo Orozco-zavala | Licensed Vocational Nurse | 85 Ramona Expressway, Suite 1, Perris, CA 92571 | 2017-08-22 |
| 1396267365 | National Vision, Inc. | Technician/Technologist | 1850 N Perris Boulevard, Suite 40, Perris, CA 92571 | 2017-07-12 |
| 1336669506 | Gary Huang | Optometrist | 1850 N Perris Boulevard Ste 40, Perris, CA 92571 | 2017-06-20 |
| 1750814745 | New Beginnings Residential Tf | Residential Treatment Facility, Emotionally Disturbed Children | 106 Worth St, Perris, CA 92571 | 2017-04-06 |
| 1013456235 | Sohal and Pham Dental Corporation | Dentist | 1820 Perris Blvd, Suite 70, Perris, CA 92571 | 2017-02-21 |
| 1093267569 | New Beginnings Residential Tf | Residential Treatment Facility, Emotionally Disturbed Children | 2464 Slew of Gold Ct, Perris, CA 92571 | 2016-10-31 |
| Find all providers in zip 92571 | ||||
| Taxonomy Code | 164X00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Vocational Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588180459 | Eduardo Orozco-zavala | Licensed Vocational Nurse | 85 Ramona Expressway, Suite 1, Perris, CA 92571 | 2017-08-22 |
| 1679921944 | Veronica Riley | Licensed Vocational Nurse | 3371 Saguaro Lane, Perris, CA 92571 | 2016-05-27 |
| 1629444377 | Norma Lissette Orantes | Licensed Vocational Nurse | 19128 Eldorado Rd, Perris, CA 92570-6528 | 2015-08-17 |
| 1801135827 | Jessica L Cox | Licensed Vocational Nurse | 18980 Decker Rd, Perris, CA 92570-7161 | 2013-02-11 |
| 1922384031 | Alexander V Myles | Licensed Vocational Nurse | 3815 Pansy Ln, Perris, CA 92571-7804 | 2011-11-02 |
| 1316255441 | Shannon Demetris Gray | Licensed Vocational Nurse | 2290 Willowbrook Ln, Perris, CA 92571-3517 | 2010-09-23 |
| 1285878009 | Denise Michelle Cox | Licensed Vocational Nurse | 19191 Elkhorn Rd, Perris, CA 92570-6557 | 2009-04-23 |
| 1649421611 | Jesse Anthony Williams IIi | Licensed Vocational Nurse | 3470 Landrew Rd, Perris, CA 92571-7311 | 2008-10-08 |
| 1992993141 | Teresa Elaine Sharber | Licensed Vocational Nurse | 118 Pinetree Dr, Perris, CA 92571-2681 | 2007-10-11 |
| 1720542418 | Sakia Bryson | Licensed Vocational Nurse | 85 Ramona Expy, Perris, CA 92571-7014 | 2019-01-26 |
| Find all providers in PERRIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.