Healthcare Provider Details

I. General information

NPI: 1356275481
Provider Name (Legal Business Name): TINA P PAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 SAN FERNANDO RD
SAN FERNANDO CA
91340
US

IV. Provider business mailing address

9150 WOODLEY AVE
NORTH HILLS CA
91343-2927
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-2679
  • Fax:
Mailing address:
  • Phone: 818-650-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: