Healthcare Provider Details

I. General information

NPI: 1972486249
Provider Name (Legal Business Name): MICHELLE VUONG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 E REDLANDS BLVD STE A
SAN BERNARDINO CA
92408-3760
US

IV. Provider business mailing address

245 E REDLANDS BLVD
SAN BERNARDINO CA
92408-3754
US

V. Phone/Fax

Practice location:
  • Phone: 909-654-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: