Healthcare Provider Details

I. General information

NPI: 1629556469
Provider Name (Legal Business Name): MELANIE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

7946 ASTER CIR
BUENA PARK CA
90620-1915
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-2648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number36346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: