Healthcare Provider Details

I. General information

NPI: 1841705852
Provider Name (Legal Business Name): MARIANNE NGA NGUYEN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
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:
Mailing address:
  • Phone: 714-622-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIANNE NGUYEN
Title or Position: DIRECTOR
Credential: MD
Phone: 714-622-5133