Provider Demographics
NPI:1871324905
Name:BREMPONG, JOYCE (NP)
Entity type:Individual
Prefix:MISS
First Name:JOYCE
Middle Name:
Last Name:BREMPONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 CANTERBURY DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6822
Mailing Address - Country:US
Mailing Address - Phone:310-384-0245
Mailing Address - Fax:
Practice Address - Street 1:3800 KILROY AIRPORT WAY STE 270
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2497
Practice Address - Country:US
Practice Address - Phone:800-964-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026756363L00000X
CANP95026756363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner