Healthcare Provider Details

I. General information

NPI: 1619434107
Provider Name (Legal Business Name): THOA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

V. Phone/Fax

Practice location:
  • Phone: 949-357-2556
  • Fax:
Mailing address:
  • Phone: 949-357-2556
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: