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General NPI Number Information
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NPI Number | 1568451771
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Entity Type | Individual
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Provider Name | PREMESH JINA RPH
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 510 W CENTRAL AVE STE A
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City | BREA
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State | CA
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Zip | 92821-3032
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Country | US
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Telephone | 844-458-6224
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Fax |
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Provider Business Mailing Address
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Address Line | 54 JUNEBERRY
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City | IRVINE
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State | CA
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Zip | 92606-4503
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Country | US
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Telephone | 844-458-6224
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47066
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License Number State | CA
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