Healthcare Provider Details

I. General information

NPI: 1790463875
Provider Name (Legal Business Name): PATRISIA NGUYEN AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W 118TH ST STE 200
HAWTHORNE CA
90250-2257
US

IV. Provider business mailing address

4477 W 118TH ST STE 200
HAWTHORNE CA
90250-2257
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-4440
  • Fax:
Mailing address:
  • Phone: 310-675-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95025599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: