Healthcare Provider Details

I. General information

NPI: 1215433776
Provider Name (Legal Business Name): NADIA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8363 RESEDA BLVD STE 11
NORTHRIDGE CA
91324-4694
US

IV. Provider business mailing address

8541 ENFIELD AVE
NORTHRIDGE CA
91325-3813
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax:
Mailing address:
  • Phone: 818-669-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95007778
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: