Healthcare Provider Details

I. General information

NPI: 1225625627
Provider Name (Legal Business Name): BICH N. NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 SANDROCK RD
SAN DIEGO CA
92123-2240
US

IV. Provider business mailing address

12071 ALTA CARMEL CT UNIT 84
SAN DIEGO CA
92128-3815
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-0047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number831296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: