Healthcare Provider Details

I. General information

NPI: 1780189670
Provider Name (Legal Business Name): ANGIE SONGNGAN NGUYEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W 1ST ST STE 101
SANTA ANA CA
92703-3757
US

IV. Provider business mailing address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-9700
  • Fax: 714-542-9708
Mailing address:
  • Phone: 949-215-5055
  • Fax: 949-215-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95008636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: