Healthcare Provider Details

I. General information

NPI: 1003381419
Provider Name (Legal Business Name): CINDY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date: 07/25/2024
Reactivation Date: 08/26/2024

III. Provider practice location address

2001 DWIGHT WAY STE 2182
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY STE 2182
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: