Healthcare Provider Details

I. General information

NPI: 1528529195
Provider Name (Legal Business Name): ANNIE D TRAN-NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W 190TH ST
TORRANCE CA
90503-1004
US

IV. Provider business mailing address

5020 W 190TH ST
TORRANCE CA
90503-1004
US

V. Phone/Fax

Practice location:
  • Phone: 310-370-5607
  • Fax:
Mailing address:
  • Phone: 310-370-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: