VIRGINIA INTHAVONG

MODESTO, CA
NPI1932741139
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: CA  95013866)
Additional Taxonomies363L00000X Nurse Practitioner
(Licence: KS  xxxxxx)
Enumeration Date2019-10-09
Last Update Date2022-02-22
Business Address
VIRGINIA INTHAVONG FNP
1717 LAS VEGAS ST
MODESTO, CA 95358-5500
Phone number: 866-682-4842
Mailing Address
VIRGINIA INTHAVONG FNP
2012 LANDING CT
MODESTO, CA 95357-0857
Phone number: