Basic Information
| Provider Information | |||||||||
| NPI: | 1962715060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMONTE | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624919761 | ||||||||
| FaxNumber: | 5624919264 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624919761 | ||||||||
| FaxNumber: | 5624919264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2010 | ||||||||
| LastUpdateDate: | 07/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | NP18591 | CA | Y | Nursing Service Providers | Registered Nurse | Emergency |
ID Information
| ID | Type | State | Issuer | Description | NP18591 | 01 | CA | NP LICENSE | OTHER |