Healthcare Provider Details

I. General information

NPI: 1669864849
Provider Name (Legal Business Name): MIMI HOANG PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26024 ACERO STE 110
MISSION VIEJO CA
92691-2768
US

IV. Provider business mailing address

26024 ACERO STE 110
MISSION VIEJO CA
92691-2768
US

V. Phone/Fax

Practice location:
  • Phone: 949-755-6443
  • Fax: 949-755-6453
Mailing address:
  • Phone: 949-755-6443
  • Fax: 949-755-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH58300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: