Healthcare Provider Details

I. General information

NPI: 1902407836
Provider Name (Legal Business Name): CHRISTINA TOCHAU NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 RAINWOOD ST
SIMI VALLEY CA
93063-5019
US

IV. Provider business mailing address

5219 RAINWOOD ST
SIMI VALLEY CA
93063-5019
US

V. Phone/Fax

Practice location:
  • Phone: 805-302-7669
  • Fax:
Mailing address:
  • Phone: 805-302-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: