Healthcare Provider Details

I. General information

NPI: 1407462526
Provider Name (Legal Business Name): TRACY THUY VU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 JEFFERSON ST NE
ALBUQUERQUE NM
87109-3582
US

IV. Provider business mailing address

23415 TIRINO SHORES DR
KATY TX
77493-2853
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-0404
  • Fax:
Mailing address:
  • Phone: 281-381-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86638
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2024-0111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: