Healthcare Provider Details

I. General information

NPI: 1235713082
Provider Name (Legal Business Name): ALDRIN BERONCAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 EL TORO RD
LAGUNA WOODS CA
92637-2775
US

IV. Provider business mailing address

11 ATLANTA
IRVINE CA
92620-2503
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-0391
  • Fax:
Mailing address:
  • Phone: 714-808-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number152360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: