Individual
DAOPHASOUK CHANNITA MARKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6816 PACIFIC BLVD STE 210, HUNTINGTON PARK, CA 90255-4654
(714) 779-8329
Mailing address
6816 PACIFIC BLVD STE 210, HUNTINGTON PARK, CA 90255-4654
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95017348
CA
Other
Enumeration date
05/27/2021
Last updated
05/12/2024
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