Provider Demographics
NPI:1578133112
Name:NGO, ALINE NGOC
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:NGOC
Last Name:NGO
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 1:6320 CABARET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2116
Mailing Address - Country:US
Mailing Address - Phone:707-246-6325
Mailing Address - Fax:
Practice Address - Street 1:6320 CABARET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2116
Practice Address - Country:US
Practice Address - Phone:707-246-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist