Healthcare Provider Details

I. General information

NPI: 1194311167
Provider Name (Legal Business Name): CINDY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date: 04/03/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1794
US

IV. Provider business mailing address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1794
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-7296
  • Fax:
Mailing address:
  • Phone: 831-462-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: