Healthcare Provider Details

I. General information

NPI: 1144330051
Provider Name (Legal Business Name): VICTOR V. NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39765 DATE ST, SUITE 102
MURRIETA CA
92563
US

IV. Provider business mailing address

PO BOX 892788
TEMECULA CA
92589-2788
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-4665
  • Fax: 951-894-4773
Mailing address:
  • Phone: 951-894-4665
  • Fax: 951-894-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA68591
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA68591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: