Healthcare Provider Details

I. General information

NPI: 1598445736
Provider Name (Legal Business Name): DARLENE NGUYEN NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N FRESNO ST FL 1
FRESNO CA
93720-2950
US

IV. Provider business mailing address

3317 MOULIN LN
SAN JOSE CA
95135-1065
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-7463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number63065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: