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Individual

MANIPHANH NORAKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, FNP-C

Contact information

Practice address
4276 54TH PL STE C, SAN DIEGO, CA 92115-6011
(951) 442-6787
Mailing address
2402 JUDSON ST, SAN DIEGO, CA 92111-6214
(858) 397-8000

Taxonomy

Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
662213
CA
363LF0000X
Family Nurse Practitioner
F12180372
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
F12180372
CA

Other

Enumeration date
09/27/2019
Last updated
09/27/2019
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