Healthcare Provider Details

I. General information

NPI: 1487841441
Provider Name (Legal Business Name): TRUC NHU NGUYEN RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 BRANT ST. APT. #4
SAN DIEGO CA
92103-1991
US

IV. Provider business mailing address

4057 BRANT ST. APT. #4
SAN DIEGO CA
92103-1991
US

V. Phone/Fax

Practice location:
  • Phone: 858-204-2071
  • Fax:
Mailing address:
  • Phone: 858-204-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: