Healthcare Provider Details

I. General information

NPI: 1760142111
Provider Name (Legal Business Name): CHRISTINE NGUYEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 11/05/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 104
IRVINE CA
92618-2126
US

IV. Provider business mailing address

15825 LAGUNA CANYON RD STE 104
IRVINE CA
92618-2126
US

V. Phone/Fax

Practice location:
  • Phone: 949-585-9870
  • Fax: 949-585-9331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: