Healthcare Provider Details

I. General information

NPI: 1932595220
Provider Name (Legal Business Name): LYLEANNA K NGUYEN MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 ORANGETHORPE AVE 9A
BUENA PARK CA
90621-3341
US

IV. Provider business mailing address

13322 SANDRA PL
GARDEN GROVE CA
92843-2712
US

V. Phone/Fax

Practice location:
  • Phone: 714-503-6550
  • Fax: 714-562-8729
Mailing address:
  • Phone: 714-360-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95056697
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: