Healthcare Provider Details

I. General information

NPI: 1487586046
Provider Name (Legal Business Name): THAI-HANH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W 5TH AVE STE C
ESCONDIDO CA
92025-4851
US

IV. Provider business mailing address

987 S FIREFLY DR
ANAHEIM CA
92808-1504
US

V. Phone/Fax

Practice location:
  • Phone: 760-536-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: