MEDICARE: MISS EVELYNE NGUYEN VAN MAU

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	51486	CA

General Provider Information

NPI Number	:	1750663894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EVELYNE NGUYEN VAN MAU

Provider Business Mailing Address
First Line	:	1600 E 3RD AVE APT 2405
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-2155
Country	:	US
Telephone Number	:	650-583-8685
Fax Number	:	650-583-9156

Provider Business Practice Location Address
First Line	:	399 EL CAMINO REAL
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5923
Country	:	US
Telephone Number	:	650-583-8685
Fax Number	:	650-583-9156

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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