Healthcare Provider Details

I. General information

NPI: 1215645247
Provider Name (Legal Business Name): MARINA NHUT NGUYEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COFFEE RD STE 200
MODESTO CA
95355-3122
US

IV. Provider business mailing address

1552 COFFEE RD STE 200
MODESTO CA
95355-3122
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7168
  • Fax:
Mailing address:
  • Phone: 209-248-7168
  • Fax: 209-222-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: