Healthcare Provider Details

I. General information

NPI: 1053516542
Provider Name (Legal Business Name): QUANG T NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N PECOS RD STE 100
HENDERSON NV
89074-7364
US

IV. Provider business mailing address

229 N PECOS RD STE 100
HENDERSON NV
89074-7364
US

V. Phone/Fax

Practice location:
  • Phone: 702-605-5750
  • Fax: 702-605-5751
Mailing address:
  • Phone: 702-605-5750
  • Fax: 702-605-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR932
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberDO1414
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: