Healthcare Provider Details

I. General information

NPI: 1629097936
Provider Name (Legal Business Name): VAN NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 W CENTRAL BLVD
ORLANDO FL
32805-1809
US

IV. Provider business mailing address

4549 SADDLEWORTH CIR
ORLANDO FL
32826-4125
US

V. Phone/Fax

Practice location:
  • Phone: 407-836-2645
  • Fax: 407-836-2672
Mailing address:
  • Phone: 407-737-4052
  • Fax: 407-836-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0036511
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME0036511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: