Healthcare Provider Details

I. General information

NPI: 1073768289
Provider Name (Legal Business Name): JOANNA CHEUNG RD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number71405
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1006649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: