MEDICARE: VINCENT 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	53335	CA

General Provider Information

NPI Number	:	1902348394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT NGUYEN

Provider Business Mailing Address
First Line	:	4153-B UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1421
Country	:	US
Telephone Number	:	619-693-5860
Fax Number	:	619-693-5850

Provider Business Practice Location Address
First Line	:	4153B UNIVERSITY AVE.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1421
Country	:	US
Telephone Number	:	619-693-5860
Fax Number	:	619-693-5850

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

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	11/16/2016

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Directions to “ VINCENT NGUYEN ” Practice Location

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