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1649762188
PATANA PONGVARIN
COSTA MESA, CA
NPI
1649762188
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
163WA0400X Registered Nurse, Addiction (Substance Use Disorder)
(Licence: CA VN227571)
Enumeration Date
2018-05-31
Last Update Date
2018-05-31
Business Address
PATANA PONGVARIN
275 VICTORIA ST STE 1H
COSTA MESA, CA 92627-1906
Phone number: 949-629-2862
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Mailing Address
PATANA PONGVARIN
275 VICTORIA ST STE 1H
COSTA MESA, CA 92627-1906
Phone number: 949-629-2862
Copy
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