MEDICARE: TRANG NGUYEN

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	62962	CA

General Provider Information

NPI Number	:	1790108967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANG NGUYEN

Provider Business Mailing Address
First Line	:	811 AVENIDA TALEGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6523
Country	:	US
Telephone Number	:	949-940-0167
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 AVENIDA TALEGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6523
Country	:	US
Telephone Number	:	949-940-0167
Fax Number	:

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

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “ TRANG NGUYEN ” Practice Location

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