Individual
TRYSARI SUDIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2810 LONG BEACH BLVD, LONG BEACH, CA 90806-1558
(626) 709-7802
Mailing address
2810 LONG BEACH BLVD, LONG BEACH, CA 90806-1558
(626) 709-7802
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95018240
CA
Other
Enumeration date
04/19/2023
Last updated
05/26/2023
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