Christine Joy Phongdara, N.P.

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

504575 Issued in CA

Practice address

4990 Arlington Ave Ste D
Riverside, CA 92504-2757

Phone

(951) 785-9011

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: christine.phongdara.p1@direct.metro.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1659589489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8812 E CRESTVIEW LN",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928081663",
            "telephone_number": "714-281-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4990 ARLINGTON AVE STE D",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925042757",
            "telephone_number": "951-785-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 W La Veta Ave",
            "address_2": "Suite 770",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928684223",
            "country_code": "US",
            "telephone_number": "714-835-8715",
            "fax_number": "714-835-2960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHONGDARA",
        "first_name": "CHRISTINE",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "504575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Management Services of California, LLC

• Women's Health Nurse Practitioner in Riverside, CA
• Providers in Riverside, CA by specialty
• Women's Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.