Provider Demographics
NPI:1376826990
Name:NGUYEN, KATRINA TAM-ANH
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:TAM-ANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2134
Mailing Address - Country:US
Mailing Address - Phone:714-670-8920
Mailing Address - Fax:714-670-8925
Practice Address - Street 1:5961 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2134
Practice Address - Country:US
Practice Address - Phone:714-670-8920
Practice Address - Fax:714-670-8925
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist