Healthcare Provider Details

I. General information

NPI: 1952998726
Provider Name (Legal Business Name): OLIVIA VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S BROOKHURST ST
ANAHEIM CA
92804-3580
US

IV. Provider business mailing address

14291 EUCLID ST STE D115
GARDEN GROVE CA
92843-4985
US

V. Phone/Fax

Practice location:
  • Phone: 714-778-3123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: