Healthcare Provider Details

I. General information

NPI: 1245551654
Provider Name (Legal Business Name): MS. DIEU HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 06/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17017 OLD LAKE RD
RIVERSIDE CA
92503-0249
US

IV. Provider business mailing address

17017 OLD LAKE RD
RIVERSIDE CA
92503-0249
US

V. Phone/Fax

Practice location:
  • Phone: 951-233-7289
  • Fax:
Mailing address:
  • Phone: 951-358-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: