Healthcare Provider Details

I. General information

NPI: 1255962023
Provider Name (Legal Business Name): SAN HUE LY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N EL CIELO RD
PALM SPRINGS CA
92262-6992
US

IV. Provider business mailing address

2088 N BRECKENRIDGE ST
ORANGE CA
92867-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-6560
  • Fax:
Mailing address:
  • Phone: 805-201-5127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82029
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number82029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: