Healthcare Provider Details

I. General information

NPI: 1912214891
Provider Name (Legal Business Name): MS. TRINH THI TU NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 12/06/2021
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 4TH ST FL 2
SANTA ANA CA
92705-3910
US

IV. Provider business mailing address

1450 DEAUVILLE PL
COSTA MESA CA
92626-2628
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6480
  • Fax:
Mailing address:
  • Phone: 714-794-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: