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General NPI Number Information
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NPI Number | 1578126652
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Entity Type | Individual
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Provider Name | JESSICA NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 21051 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91303-1746
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Country | US
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Telephone | 818-348-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 19108 LANARK ST
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City | RESEDA
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State | CA
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Zip | 91335-1118
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Country | US
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Telephone | 818-428-0584
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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 | 80454
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License Number State | CA
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