MEDICARE: QUOC VIET NGUYEN

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	146N00000X	Basic Emergency Medical Technician	1065-4627-5586	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1065-4627-5586	OTHER	CA	NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIAN

General Provider Information

NPI Number	:	1881353548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUOC VIET NGUYEN

Provider Business Mailing Address
First Line	:	4375 BENHURST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-3013
Country	:	US
Telephone Number	:	858-776-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	7614 LEMON AVE
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1619
Country	:	US
Telephone Number	:	619-303-6705
Fax Number	:

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

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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Directions to “ QUOC VIET NGUYEN ” Practice Location

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