Healthcare Provider Details

I. General information

NPI: 1902206758
Provider Name (Legal Business Name): PAIDEIA LE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18685 MAIN ST STE 105
HUNTINGTON BEACH CA
92648-1721
US

IV. Provider business mailing address

18685 MAIN ST # 101-168
HUNTINGTON BEACH CA
92648-1723
US

V. Phone/Fax

Practice location:
  • Phone: 714-916-0593
  • Fax:
Mailing address:
  • Phone: 714-916-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number70932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: