MEDICARE: AILEEN NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	83502	CA

General Provider Information

NPI Number	:	1366190456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILEEN NGUYEN

Provider Business Mailing Address
First Line	:	5495 LOS MONTEROS
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-5110
Country	:	US
Telephone Number	:	714-325-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	5495 LOS MONTEROS
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-5110
Country	:	US
Telephone Number	:	714-325-9016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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Directions to “ AILEEN NGUYEN ” Practice Location

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