Healthcare Provider Details

I. General information

NPI: 1902478779
Provider Name (Legal Business Name): OLIVIA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 201
SANTA BARBARA CA
93105-4344
US

IV. Provider business mailing address

414 E COTA ST
SANTA BARBARA CA
93101-1624
US

V. Phone/Fax

Practice location:
  • Phone: 805-324-8336
  • Fax: 805-324-5174
Mailing address:
  • Phone: 805-324-8336
  • Fax: 805-324-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA196357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: