Healthcare Provider Details

I. General information

NPI: 1154566867
Provider Name (Legal Business Name): MINH TRAM NGUYEN DAO L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR #8781
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 W ARBOR DR #8781
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6995
  • Fax: 619-543-7368
Mailing address:
  • Phone: 619-543-6995
  • Fax: 619-543-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: