Healthcare Provider Details

I. General information

NPI: 1013585108
Provider Name (Legal Business Name): MRS. STEPHANIE TRAM NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8856
  • Fax: 714-509-4371
Mailing address:
  • Phone: 714-509-8856
  • Fax: 714-509-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number49732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: