Healthcare Provider Details

I. General information

NPI: 1013389345
Provider Name (Legal Business Name): TINA THAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 EL CAMINO REAL
CARLSBAD CA
92008-1273
US

IV. Provider business mailing address

1464 CALLE MARBELLA
OCEANSIDE CA
92056-6968
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: