Healthcare Provider Details

I. General information

NPI: 1457549453
Provider Name (Legal Business Name): HIEU NGOC NGUYEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40700 CALIFORNIA OAKS RD SUITE 202
MURRIETA CA
92562-5789
US

IV. Provider business mailing address

39277 TURTLE BAY UNIT A
MURRIETA CA
92563-7850
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-5072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: