Healthcare Provider Details

I. General information

NPI: 1538826961
Provider Name (Legal Business Name): MRS. MARIA CRISTINA AHMADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12491 VALLEY VIEW ST
GARDEN GROVE CA
92845-2032
US

IV. Provider business mailing address

729 S KNOTT AVE APT 106
ANAHEIM CA
92804-2991
US

V. Phone/Fax

Practice location:
  • Phone: 714-894-9230
  • Fax: 714-891-5485
Mailing address:
  • Phone: 714-420-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number168922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: