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General NPI Number Information
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NPI Number | 1538781505
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Entity Type | Individual
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Provider Name | JINA VINH DETTMAN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1550 W MANCHESTER AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-5424
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Country | US
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Telephone | 323-565-3101
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Fax | 323-565-3100
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Provider Business Mailing Address
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Address Line | 415 MOONEY DR APT C
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City | MONTEREY PARK
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State | CA
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Zip | 91755-4124
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Country | US
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Telephone | 626-202-6236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH52670
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License Number State | CA
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