Provider Demographics
NPI:1275413809
Name:PRUDHOMME, JOANNA MARIE PASION
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE PASION
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 E THOMANN DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5288
Mailing Address - Country:US
Mailing Address - Phone:714-414-9794
Mailing Address - Fax:
Practice Address - Street 1:1066 E THOMANN DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5288
Practice Address - Country:US
Practice Address - Phone:714-414-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA763068163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse