Provider Demographics
NPI:1750663894
Name:NGUYEN VAN MAU, EVELYNE
Entity Type:Individual
Prefix:MISS
First Name:EVELYNE
Middle Name:
Last Name:NGUYEN VAN MAU
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 1:1600 E 3RD AVE APT 2405
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2155
Mailing Address - Country:US
Mailing Address - Phone:650-583-8685
Mailing Address - Fax:650-583-9156
Practice Address - Street 1:399 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5923
Practice Address - Country:US
Practice Address - Phone:650-583-8685
Practice Address - Fax:650-583-9156
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist