Healthcare Provider Details

I. General information

NPI: 1669884037
Provider Name (Legal Business Name): MINA SHENOUDA PHARM.D. APP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12254 BELLFLOWER BLVD
DOWNEY CA
90242-2804
US

IV. Provider business mailing address

13381 HEATHER LEE ST
EASTVALE CA
92880-3411
US

V. Phone/Fax

Practice location:
  • Phone: 951-285-6810
  • Fax:
Mailing address:
  • Phone: 951-285-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68092
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10333
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number68092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: