Healthcare Provider Details

I. General information

NPI: 1750783940
Provider Name (Legal Business Name): STEPHANIE VUONG NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E IMPERIAL HWY STE 140
LA HABRA CA
90631
US

IV. Provider business mailing address

PO BOX 27023
SANTA ANA CA
92799-7023
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax:
Mailing address:
  • Phone: 714-517-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: