Healthcare Provider Details

I. General information

NPI: 1437419082
Provider Name (Legal Business Name): LIA H NGUYEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 LOMA DR SUITE 202
LOS ANGELES CA
90017-1103
US

IV. Provider business mailing address

6000 N FIGUEROA ST
LOS ANGELES CA
90042-4232
US

V. Phone/Fax

Practice location:
  • Phone: 213-201-5800
  • Fax: 213-201-5840
Mailing address:
  • Phone: 323-254-5291
  • Fax: 323-254-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number741334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: