Healthcare Provider Details

I. General information

NPI: 1932340239
Provider Name (Legal Business Name): TINA PHUONG DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 PALM AVE
SAN DIEGO CA
92154-8404
US

IV. Provider business mailing address

10956 PORTOBELO DR
SAN DIEGO CA
92124-1181
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-5300
  • Fax: 619-662-5317
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: