Healthcare Provider Details

I. General information

NPI: 1225488505
Provider Name (Legal Business Name): MICHAL MINGURA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 12/23/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 HOWE ST
OAKLAND CA
94611-5312
US

IV. Provider business mailing address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1699
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6141
  • Fax:
Mailing address:
  • Phone: 714-872-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberTBD
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number76119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: