Provider Demographics
NPI:1144998378
Name:UONG, KRYSTAL BERMUDEZ (FNP-C)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:BERMUDEZ
Last Name:UONG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:TAGUPA
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:437 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3456
Mailing Address - Country:US
Mailing Address - Phone:909-988-2555
Mailing Address - Fax:
Practice Address - Street 1:437 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3456
Practice Address - Country:US
Practice Address - Phone:909-988-2555
Practice Address - Fax:909-988-4447
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021232363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily