Healthcare Provider Details

I. General information

NPI: 1417460247
Provider Name (Legal Business Name): NGUYEN D DAO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N WATERMAN AVE STE C
SAN BERNARDINO CA
92410-3808
US

IV. Provider business mailing address

1033 N WATERMAN AVE STE C
SAN BERNARDINO CA
92410-3808
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-2739
  • Fax: 909-885-8880
Mailing address:
  • Phone: 909-884-2739
  • Fax: 909-885-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: