Healthcare Provider Details

I. General information

NPI: 1700863644
Provider Name (Legal Business Name): MARIANNE NGA NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8341 WESTMINSTER BLVD STE 104
WESTMINSTER CA
92683-8337
US

IV. Provider business mailing address

8341 WESTMINSTER BLVD STE 104
WESTMINSTER CA
92683-8337
US

V. Phone/Fax

Practice location:
  • Phone: 714-622-5133
  • Fax: 714-622-5641
Mailing address:
  • Phone: 714-622-5133
  • Fax: 714-622-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: