Healthcare Provider Details

I. General information

NPI: 1467093351
Provider Name (Legal Business Name): LYLY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 HIBISCUS DR. APT B 112
REDLANDS CA
92373
US

IV. Provider business mailing address

528 HIBISCUS DR APT B112
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 626-416-8091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: