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General NPI Number Information
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NPI Number | 1750929675
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Entity Type | Individual
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Provider Name | JASMINE TRUONG
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Gender | Female
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 211 E 17TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3831
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Country | US
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Telephone | 949-646-4960
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Fax |
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Provider Business Mailing Address
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Address Line | 9630 LA CAPILLA AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3552
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Country | US
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Telephone |
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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 | 81312
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License Number State | CA
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