Provider Demographics
NPI:1932687191
Name:HATOUM, MAGUY
Entity Type:Individual
Prefix:
First Name:MAGUY
Middle Name:
Last Name:HATOUM
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 1:23005 VISTA DELGADO DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2238
Mailing Address - Country:US
Mailing Address - Phone:661-678-3363
Mailing Address - Fax:
Practice Address - Street 1:26550 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2353
Practice Address - Country:US
Practice Address - Phone:661-297-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist