Healthcare Provider Details

I. General information

NPI: 1144254228
Provider Name (Legal Business Name): LUONG NGUYEN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 HIGHWAY 76
PAUMA VALLEY CA
92061-9524
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 760-742-9919
  • Fax: 760-741-2782
Mailing address:
  • Phone: 760-737-2035
  • Fax: 760-741-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: