Healthcare Provider Details

I. General information

NPI: 1780660704
Provider Name (Legal Business Name): ROBERT BV NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W YOSEMITE AVE SUITE 101
MADERA CA
93637-4588
US

IV. Provider business mailing address

812 W YOSEMITE AVE SUITE 101
MADERA CA
93637-4588
US

V. Phone/Fax

Practice location:
  • Phone: 559-674-2494
  • Fax: 559-674-5608
Mailing address:
  • Phone: 559-674-2494
  • Fax: 559-674-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: