Provider Demographics
NPI:1588437289
Name:VONGSAVATH, OUANGNA (BACHELOR IN ARTS)
Entity type:Individual
Prefix:
First Name:OUANGNA
Middle Name:
Last Name:VONGSAVATH
Suffix:
Gender:F
Credentials:BACHELOR IN ARTS
Other - Prefix:
Other - First Name:OUANGNA
Other - Middle Name:
Other - Last Name:VONGSAVATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:710 MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2029
Mailing Address - Country:US
Mailing Address - Phone:424-223-3083
Mailing Address - Fax:
Practice Address - Street 1:710 MADRID AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2029
Practice Address - Country:US
Practice Address - Phone:424-223-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician