Healthcare Provider Details

I. General information

NPI: 1558630442
Provider Name (Legal Business Name): CATHERINE NGUYEN TAOSUVANNA MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE NGUYEN MPAS, PA-C

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E VALENCIA MESA DR SUITE #310
FULLERTON CA
92835-3813
US

IV. Provider business mailing address

200 W CENTER STREET PROMENADE STE 300
ANAHEIM CA
92805-3960
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5200
  • Fax: 714-446-5181
Mailing address:
  • Phone: 714-449-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA21423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21423
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: