Healthcare Provider Details

I. General information

NPI: 1770965287
Provider Name (Legal Business Name): QUANG CUU NGUYEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E CARSON ST
CARSON CA
90745-2702
US

IV. Provider business mailing address

110 E CARSON ST
CARSON CA
90745-2702
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-7237
  • Fax: 310-834-3753
Mailing address:
  • Phone: 310-830-7237
  • Fax: 310-834-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: