Healthcare Provider Details

I. General information

NPI: 1285026179
Provider Name (Legal Business Name): JIMMY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N EL CIELO RD
PALM SPRINGS CA
92262-6972
US

IV. Provider business mailing address

47750 ADAMS ST APT 112
LA QUINTA CA
92253-7102
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-6560
  • Fax:
Mailing address:
  • Phone: 909-838-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: