Healthcare Provider Details

I. General information

NPI: 1083237648
Provider Name (Legal Business Name): Y HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

3513 MARLESTA DR
SAN DIEGO CA
92111-4718
US

V. Phone/Fax

Practice location:
  • Phone: 767-339-7180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: