Provider Demographics
NPI:1790033918
Name:ROATH, TUONGVI
Entity Type:Individual
Prefix:DR
First Name:TUONGVI
Middle Name:
Last Name:ROATH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TUONGVI
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8251 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8251 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2603
Practice Address - Country:US
Practice Address - Phone:858-357-2002
Practice Address - Fax:858-877-2032
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist