MEDICARE: CHI THI NGUYEN PA-C

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	363A00000X	Physician Assistant	PA17614	TX

General Provider Information

NPI Number	:	1679339808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHI THI NGUYEN PA-C

Provider Business Mailing Address
First Line	:	8235 S NEW BRAUNFELS STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-4439
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:	210-333-0633

Provider Business Practice Location Address
First Line	:	8235 S NEW BRAUNFELS STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-4439
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:	210-333-0633

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	07/05/2024

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Directions to “ CHI THI NGUYEN PA-C” Practice Location

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