Healthcare Provider Details

I. General information

NPI: 1174843601
Provider Name (Legal Business Name): LE BACH NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 GOVERNOR DR
SAN DIEGO CA
92122-2522
US

IV. Provider business mailing address

4077 GOVERNOR DR
SAN DIEGO CA
92122-2522
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-0631
  • Fax: 858-453-0491
Mailing address:
  • Phone: 858-453-0631
  • Fax: 858-453-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: