Healthcare Provider Details

I. General information

NPI: 1134697014
Provider Name (Legal Business Name): ASHLLEY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 04/21/2026
Certification Date: 03/11/2021
Deactivation Date: 04/11/2024
Reactivation Date: 04/21/2026

III. Provider practice location address

530 E HERNDON AVE STE 105
FRESNO CA
93720-2990
US

IV. Provider business mailing address

16782 VON KARMAN AVE STE 11
IRVINE CA
92606-2417
US

V. Phone/Fax

Practice location:
  • Phone: 559-275-0559
  • Fax:
Mailing address:
  • Phone: 949-833-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-71062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: