Healthcare Provider Details

I. General information

NPI: 1558615716
Provider Name (Legal Business Name): QUANG NGUYEN DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
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 TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: QUANG T NGUYEN
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 702-605-5750