Provider Demographics
NPI:1629893375
Name:NGO, TORI VUTHANETTE
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:VUTHANETTE
Last Name:NGO
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 1:431 N TUSTIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3821
Mailing Address - Country:US
Mailing Address - Phone:714-707-5115
Mailing Address - Fax:
Practice Address - Street 1:431 N TUSTIN AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3821
Practice Address - Country:US
Practice Address - Phone:714-707-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist