Healthcare Provider Details

I. General information

NPI: 1518524677
Provider Name (Legal Business Name): NHUNG THANH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11748 MAGNOLIA AVE STE B
RIVERSIDE CA
92503-4955
US

IV. Provider business mailing address

11563 ALLWOOD DR
RIVERSIDE CA
92503-0800
US

V. Phone/Fax

Practice location:
  • Phone: 951-440-6220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12688410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: