Healthcare Provider Details

I. General information

NPI: 1417271685
Provider Name (Legal Business Name): HOANG H NGUYEN CTRS, MBSR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1986
  • Fax:
Mailing address:
  • Phone: 916-875-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number58214
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: