Healthcare Provider Details

I. General information

NPI: 1942866389
Provider Name (Legal Business Name): BAO-QUYEN NGUYEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 LAKESHORE DR
CLEARLAKE CA
95422-8107
US

IV. Provider business mailing address

967 LANE AVE STE 102
CHULA VISTA CA
91914-4530
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-4500
  • Fax:
Mailing address:
  • Phone: 619-267-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberDR.0077346
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A21061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: