Healthcare Provider Details

I. General information

NPI: 1548620388
Provider Name (Legal Business Name): VINCENT NGUYEN I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 LA PLAYA ST NE
ALBUQUERQUE NM
87111-3410
US

IV. Provider business mailing address

9508 LA PLAYA ST NE
ALBUQUERQUE NM
87111-3410
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-5614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1225
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: