Healthcare Provider Details

I. General information

NPI: 1447371208
Provider Name (Legal Business Name): HUONG LAN T NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ULRIC ST
SAN DIEGO CA
92111-6040
US

IV. Provider business mailing address

2420 ULRIC ST
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: MISS HUONG LAN THI NGUYEN
Title or Position: OWNER
Credential:
Phone: 858-467-9201