Healthcare Provider Details

I. General information

NPI: 1396447116
Provider Name (Legal Business Name): MARIAN PASCUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 BARSTOW RD
BARSTOW CA
92311-4944
US

IV. Provider business mailing address

8821 SVL BOX
VICTORVILLE CA
92395-5180
US

V. Phone/Fax

Practice location:
  • Phone: 760-252-3502
  • Fax:
Mailing address:
  • Phone: 714-232-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: