Healthcare Provider Details

I. General information

NPI: 1982910188
Provider Name (Legal Business Name): THEIA HIPE MONERA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 FOWLER DR
SAN DIEGO CA
92139-2517
US

IV. Provider business mailing address

2158 FOWLER DR
SAN DIEGO CA
92139-2517
US

V. Phone/Fax

Practice location:
  • Phone: 619-200-8951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: