Provider Demographics
NPI:1417505686
Name:NAIDOO, NUTHANA (PHARMD, BCOP)
Entity Type:Individual
Prefix:
First Name:NUTHANA
Middle Name:
Last Name:NAIDOO
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4550
Mailing Address - Country:US
Mailing Address - Phone:858-774-1571
Mailing Address - Fax:
Practice Address - Street 1:1 ADVENTIST HEALTH WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3266
Practice Address - Country:US
Practice Address - Phone:916-402-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51508141835X0200X
CA66365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology