Healthcare Provider Details

I. General information

NPI: 1447809470
Provider Name (Legal Business Name): VIVIAN N/A HOANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 GATEWAY RD
CARLSBAD CA
92009-1773
US

IV. Provider business mailing address

2650 GATEWAY RD
CARLSBAD CA
92009-1773
US

V. Phone/Fax

Practice location:
  • Phone: 760-795-2540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number798724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: