Healthcare Provider Details

I. General information

NPI: 1275403842
Provider Name (Legal Business Name): VICTORIA NGUYEN BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9889 MAGNOLIA AVE STE A
RIVERSIDE CA
92503-3581
US

IV. Provider business mailing address

9889 MAGNOLIA AVE STE A
RIVERSIDE CA
92503-3581
US

V. Phone/Fax

Practice location:
  • Phone: 951-525-3548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: