Healthcare Provider Details

I. General information

NPI: 1538761739
Provider Name (Legal Business Name): RYAN NGUYEN CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28221 CROWN VALLEY PKWY
LAGUNA NIGUEL CA
92677-1427
US

IV. Provider business mailing address

14931 BOONEY ST
WESTMINSTER CA
92683-5841
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-2011
  • Fax:
Mailing address:
  • Phone: 657-400-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: