=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558730754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NINA PIETRANGELO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2015
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1560 W 6TH ST
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882-2730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-393-6406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1560 W 6TH ST
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882-2730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-393-6406
-----------------------------------------------------
Fax | 951-393-6407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 68316
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------