Healthcare Provider Details

I. General information

NPI: 1104319003
Provider Name (Legal Business Name): MINH NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W TEHACHAPI BLVD
TEHACHAPI CA
93561-1656
US

IV. Provider business mailing address

3101 W SUNFLOWER AVE # 26422
SANTA ANA CA
92799-0101
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-3594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number70650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: