Healthcare Provider Details

I. General information

NPI: 1336006725
Provider Name (Legal Business Name): MARY HOA NGUYEN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42875 GATEWOOD ST
FREMONT CA
94538-4131
US

IV. Provider business mailing address

42875 GATEWOOD ST
FREMONT CA
94538-4131
US

V. Phone/Fax

Practice location:
  • Phone: 510-656-6438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95245150
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number250004097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: