Most Relevant Information
Provider Data
| NPI Number: | 1003553017 |
| Provider Name: | THORN EANG LVN |
| Entity Type: | Individual |
| Taxonomy Code: | 164X00000X |
| Specialty: | Licensed Vocational Nurse |
| License Number: | 689051 |
Most Important Dates
| Enumeration Date: | 05/19/2022 |
| Last Updated: | 05/19/2022 |
Provider Practice Location
829 ALLACANTE DR
CERES
CA
953077308
Practice Location Phone/Fax
| Phone: | 2096816030 |
| Fax: |
Provider Mailing Location
829 ALLACANTE DR
CERES
CA
953077308
Provider Mailing Phone/Fax
| Phone: | 2096816030 |
| Fax: |