Healthcare Provider Details

I. General information

NPI: 1184312712
Provider Name (Legal Business Name): GRACE HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MAIN ST RM 1R150
WATSONVILLE CA
95076-3027
US

IV. Provider business mailing address

1302 THE ALAMEDA APT 311
SAN JOSE CA
95126-2650
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: