Healthcare Provider Details

I. General information

NPI: 1750955423
Provider Name (Legal Business Name): JENNIFER NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3858 W CARSON ST STE 100
TORRANCE CA
90503-6705
US

IV. Provider business mailing address

3858 W CARSON ST STE 100
TORRANCE CA
90503-6705
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: