Provider Demographics
NPI:1972574853
Name:TOURGOLI, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TOURGOLI
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 1:2350 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1689
Mailing Address - Country:US
Mailing Address - Phone:714-955-7672
Mailing Address - Fax:
Practice Address - Street 1:34800 BOBWILLSON DR
Practice Address - Street 2:
Practice Address - City:SANDIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104
Practice Address - Country:US
Practice Address - Phone:619-532-8404
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist