Nina Fofang

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

95221764 Issued in CA

Practice address

301 S Glendora Ave Unit 2544
West Covina, CA 91790-5938

Phone

(972) 352-7743

NPI assigned

Jul 12, 2025

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

Enrolled in CA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1752278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752278400000",
    "number": "1699666115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S GLENDORA AVE UNIT 2544",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917905938",
            "telephone_number": "972-352-7743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S GLENDORA AVE UNIT 2544",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917905938",
            "telephone_number": "972-352-7743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOFANG",
        "first_name": "NINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-12",
        "last_updated": "2025-07-12",
        "certification_date": "2025-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95221764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Flores
• Reesabelle Flores
• Valeria Flores
• Violeta Flores
• Viviana Isabel Flores, PPS
• Afrielle Fondevilla, NP
• Florence Lin Fong, M.D.
• Meghan Lynn Foote
• Foothill Care Center II, LLC
• Foothill Care Center II, LLC

• Registered Nurse in West Covina, CA
• Providers in West Covina, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.