Healthcare Provider Details

I. General information

NPI: 1831753789
Provider Name (Legal Business Name): TRACY TRUC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18080 IMPERIAL HWY
YORBA LINDA CA
92886-3436
US

IV. Provider business mailing address

18080 IMPERIAL HWY
YORBA LINDA CA
92886-3436
US

V. Phone/Fax

Practice location:
  • Phone: 714-961-1054
  • Fax:
Mailing address:
  • Phone: 714-414-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55512
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number55512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: