Healthcare Provider Details

I. General information

NPI: 1174160410
Provider Name (Legal Business Name): DIANA NGUYEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

IV. Provider business mailing address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 714-334-5068
  • Fax:
Mailing address:
  • Phone: 949-215-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95013361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: