Healthcare Provider Details

I. General information

NPI: 1508385964
Provider Name (Legal Business Name): CARMEN TRUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081B CLAIREMONT DR
SAN DIEGO CA
92117-6802
US

IV. Provider business mailing address

1020 S 6TH ST
ALHAMBRA CA
91801-4757
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-1175
  • Fax:
Mailing address:
  • Phone: 626-510-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: