Provider Demographics
NPI:1548856115
Name:DUONG, CHRISTINE MAE BAINTO (RPH)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MAE BAINTO
Last Name:DUONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12948 WILDCAT CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-1511
Mailing Address - Country:US
Mailing Address - Phone:619-647-9639
Mailing Address - Fax:
Practice Address - Street 1:3550 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2656
Practice Address - Country:US
Practice Address - Phone:858-292-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH83906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist