Provider Demographics
NPI:1649424482
Name:TRUONG, JACQUELINE B (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:B
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E 2ND ST
Mailing Address - Street 2:HPC 2ND FLOOR SUITE 2215 OR 2255
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-469-8332
Mailing Address - Fax:909-706-3780
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 7
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3877
Practice Address - Fax:909-706-3942
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193213ES0103X
CAE4844213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery