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: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 04/11/2024
Reactivation Date: 04/21/2026

III. Provider practice location address

5321 N FRESNO ST STE 108
FRESNO CA
93710-6850
US

IV. Provider business mailing address

5321 N FRESNO ST STE 108
FRESNO CA
93710-6850
US

V. Phone/Fax

Practice location:
  • Phone: 559-954-7757
  • Fax:
Mailing address:
  • Phone: 559-954-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberCOTA-6793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: