Healthcare Provider Details

I. General information

NPI: 1407142656
Provider Name (Legal Business Name): LSHONNA DOMINIQUE NGUYEN RRW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 WILLIAMSBOURGH DR
SACRAMENTO CA
95823-2006
US

IV. Provider business mailing address

7600 TIERRA GLEN WAY
SACRAMENTO CA
95828-2315
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5766
  • Fax:
Mailing address:
  • Phone: 916-202-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: