Provider Demographics
NPI:1275030520
Name:NGUYEN, VIVIAN VAN
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:VAN
Last Name:NGUYEN
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 1:2993 LILY CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8809
Mailing Address - Country:US
Mailing Address - Phone:714-873-2327
Mailing Address - Fax:
Practice Address - Street 1:6250 VALLEY SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0970
Practice Address - Country:US
Practice Address - Phone:951-653-2969
Practice Address - Fax:951-697-1005
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist