Healthcare Provider Details

I. General information

NPI: 1437614344
Provider Name (Legal Business Name): ALICE LIU-NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 FREEBOARD DR
WEST SACRAMENTO CA
95691-5039
US

IV. Provider business mailing address

3120 FREEBOARD DR
WEST SACRAMENTO CA
95691-5039
US

V. Phone/Fax

Practice location:
  • Phone: 530-351-7975
  • Fax: 530-351-7976
Mailing address:
  • Phone: 530-351-7975
  • Fax: 530-351-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: