Healthcare Provider Details

I. General information

NPI: 1083829360
Provider Name (Legal Business Name): CLARA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E TEMPLE ST
LOS ANGELES CA
90012-4022
US

IV. Provider business mailing address

7022 POBOX
ALHAMBRA CA
91802
US

V. Phone/Fax

Practice location:
  • Phone: 213-473-6960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberG058644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: