Healthcare Provider Details

I. General information

NPI: 1740733609
Provider Name (Legal Business Name): CHRISTINE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242
US

IV. Provider business mailing address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

V. Phone/Fax

Practice location:
  • Phone: 562-401-6277
  • Fax:
Mailing address:
  • Phone: 877-726-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA3916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: