Basic Information
| Provider Information | |||||||||
| NPI: | 1841891710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THWE | ||||||||
| FirstName: | HLAHLA | ||||||||
| MiddleName: | MYET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913243603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182685543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 N PEPPER AVE | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923241819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095806333 | ||||||||
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| ProviderEnumerationDate: | 11/05/2020 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 95015105 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.