Healthcare Provider Details

I. General information

NPI: 1487357885
Provider Name (Legal Business Name): HELEN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W VISTA WAY STE 250
VISTA CA
92083-6034
US

IV. Provider business mailing address

1964 VIA CTR
VISTA CA
92081-6056
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-9900
  • Fax:
Mailing address:
  • Phone: 888-743-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62422
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberPA62422
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberPA62422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: