Provider Demographics
NPI:1144638735
Name:NGUYEN, PAULINA
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
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:PO BOX 2672
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-7672
Mailing Address - Country:US
Mailing Address - Phone:510-475-5523
Mailing Address - Fax:510-475-5523
Practice Address - Street 1:30600 DYER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1717
Practice Address - Country:US
Practice Address - Phone:510-475-5523
Practice Address - Fax:510-475-4253
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist