Skip Navigation

Provider Information for 1710462825

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1710462825

Calendar   Last Updated:  2018-09-25
  Certification Date: 


Name Value
NPI 1710462825
Enumeration Date 2018-09-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1887 ISLA DEL CAMPANERO
SAN YSIDRO, CA 92173-1825
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 4501 SAND CREEK RD
ANTIOCH, CA 94531-8687
United States

Phone: 925-813-6500 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 183500000X - Pharmacist CA 77385