Juan Cerda-Ofogh
Individual provider Active NPI Pharmacist · Corona, CA
NPI 1104191345 · NPPES record last updated Mar 21, 2012
Key facts
- NPI
- 1104191345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 59446 (CA)
- Practice address
- 1596 Vandagriff Way
Corona, CA 92883-7653 - Phone
- (951) 272-3434
- NPI assigned
- Mar 21, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59446 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 59446 | CA | Yes |
Addresses
Primary practice location
1596 Vandagriff Way
Corona, CA 92883-7653
Mailing address
1596 Vandagriff Way
Corona, CA 92883-7653
Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.