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Organization
PONO PSYCHIATRY & WELLNESS A PROFESSIONAL NURSING CORPORATION
Active
Organization
PONO PSYCHIATRY & WELLNESS A PROFESSIONAL NURSING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICMAR BURGONIO (PROVIDER)
(661) 313-2166
Entity
Organization
Contact information
Practice address
4539 PEPPERWOOD AVE, LONG BEACH, CA 90808-1070
(661) 313-2166
Mailing address
4539 PEPPERWOOD AVE, LONG BEACH, CA 90808-1070
(661) 313-2166
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/13/2026
Last updated
08/12/2026
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