Healthcare Provider Details

I. General information

NPI: 1922673193
Provider Name (Legal Business Name): FERNANDO TOVAR CERDA PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

107 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-8026
  • Fax: 310-639-9314
Mailing address:
  • Phone: 310-639-8026
  • Fax: 310-639-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number146068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: