Provider Demographics
NPI:1467729772
Name:NGUYEN, JACINTA
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:
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 1:25601 JERONIMO RD
Mailing Address - Street 2:T-2163
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2794
Mailing Address - Country:US
Mailing Address - Phone:949-680-1065
Mailing Address - Fax:949-680-1075
Practice Address - Street 1:25601 JERONIMO RD
Practice Address - Street 2:T-2163
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2794
Practice Address - Country:US
Practice Address - Phone:714-680-1065
Practice Address - Fax:949-680-1075
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist