Healthcare Provider Details

I. General information

NPI: 1871136929
Provider Name (Legal Business Name): RAYMOND TRAN NGUYEN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4684 ONTARIO MILLS PKWY STE 200
ONTARIO CA
91764-5151
US

IV. Provider business mailing address

4684 ONTARIO MILLS PKWY STE 200
ONTARIO CA
91764-5151
US

V. Phone/Fax

Practice location:
  • Phone: 626-621-3572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013061
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95013061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: