Healthcare Provider Details

I. General information

NPI: 1770108532
Provider Name (Legal Business Name): ANGIE THANH AN NGUYEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

8881 LA CARTERA ST
SAN DIEGO CA
92129-3310
US

V. Phone/Fax

Practice location:
  • Phone: 858-616-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: