Individual
EBONIE FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3125 N BROADWAY, LOS ANGELES, CA 90031-2703
(213) 482-6400
Mailing address
3125 N BROADWAY, LOS ANGELES, CA 90031-2703
(213) 482-6400
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
723327
CA
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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