MEDICARE: MR. TREVOR VAN BUI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	53416	CA

General Provider Information

NPI Number	:	1316152473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR VAN BUI

Provider Business Mailing Address
First Line	:	13125 VIA CANYON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2255
Country	:	US
Telephone Number	:	858-538-2796
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2212
Country	:	US
Telephone Number	:	619-563-0802
Fax Number	:	619-563-0633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	05/15/2008

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