MEDICARE: REBECCA NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	A191345	CA

General Provider Information

NPI Number	:	1164982922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA NGUYEN MD

Provider Business Mailing Address
First Line	:	3615 LAS POSAS RD STE F100
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1428
Country	:	US
Telephone Number	:	805-484-2813
Fax Number	:	805-484-2316

Provider Business Practice Location Address
First Line	:	3615 LAS POSAS RD STE F100
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1428
Country	:	US
Telephone Number	:	805-484-2813
Fax Number	:	805-484-2316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	10/10/2023

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