Healthcare Provider Details

I. General information

NPI: 1649647058
Provider Name (Legal Business Name): JONATHAN NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W EL MONTE WAY
DINUBA CA
93618-3493
US

IV. Provider business mailing address

107 E SIERRA AVE APT 127
FRESNO CA
93710-3634
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-0842
  • Fax:
Mailing address:
  • Phone: 714-743-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH70757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: