Healthcare Provider Details

I. General information

NPI: 1386717122
Provider Name (Legal Business Name): MS. HELLEN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ULRIC STREET
SAN DIEGO CA
92111-6040
US

IV. Provider business mailing address

2420 ULRIC STREET
SAN DIEGO CA
92111-6040
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-9201
  • Fax: 858-467-0644
Mailing address:
  • Phone: 858-467-9201
  • Fax: 858-467-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHY45942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: