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Individual

DR. JACQUELINE TRUONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
15070 SUMMIT AVE STE 400, FONTANA, CA 92336-5387
(909) 463-4655
(909) 463-9655
Mailing address
15070 SUMMIT AVE, SUITE 400, FONTANA, CA 92336-5387
(909) 463-4655
(909) 463-9655

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
11766T
CA
152W00000X
Optometrist
Primary
11766TLG
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9425438
CA
Enumeration date
12/05/2006
Last updated
10/14/2011
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