Healthcare Provider Details

I. General information

NPI: 1437972726
Provider Name (Legal Business Name): KAITLYN ANN TRINH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 EL CAMINO REAL STE 101
SAN DIEGO CA
92130-2541
US

IV. Provider business mailing address

2429 DEL AMO BLVD
LAKEWOOD CA
90712-2833
US

V. Phone/Fax

Practice location:
  • Phone: 858-752-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: