Basic Information
| Provider Information | |||||||||
| NPI: | 1831672724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANGAN | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | LYLE | ||||||||
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| Credential: | RN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16416 FLALLON AVE | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906507027 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3330 LOMITA BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103259110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 833834 | CA | N | Nursing Service Providers | Registered Nurse | 363LA2100X | NP95009782 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.