Healthcare Provider Details

I. General information

NPI: 1598978934
Provider Name (Legal Business Name): ALAN TUYEN VUONG MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 SANTO RD SUITE C
SAN DIEGO CA
92124-1196
US

IV. Provider business mailing address

PO BOX 420063
SAN DIEGO CA
92142-0063
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-4285
  • Fax: 858-292-5827
Mailing address:
  • Phone: 858-761-8130
  • Fax: 858-292-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: