Healthcare Provider Details

I. General information

NPI: 1568816858
Provider Name (Legal Business Name): TRINH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE. RIVERSIDE COMMUNITY HOSPITAL, GME OFFICE
RIVERSIDE CA
92501
US

IV. Provider business mailing address

4445 MAGNOLIA AVE. RIVERSIDE COMMUNITY HOSPITAL, GME OFFICE
RIVERSIDE CA
92501
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number104398
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: