Provider Demographics
NPI:1407175045
Name:DULDULAO, VENELYN ACOSTA
Entity type:Individual
Prefix:
First Name:VENELYN
Middle Name:ACOSTA
Last Name:DULDULAO
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 1:19 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5817
Mailing Address - Country:US
Mailing Address - Phone:562-900-6719
Mailing Address - Fax:
Practice Address - Street 1:5128 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5322
Practice Address - Country:US
Practice Address - Phone:562-433-0456
Practice Address - Fax:562-433-4586
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist