Healthcare Provider Details

I. General information

NPI: 1437783537
Provider Name (Legal Business Name): GIA UYEN T DIEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3492 S CHIEFTAIN ST
LAS VEGAS NV
89117-6723
US

IV. Provider business mailing address

3492 S CHIEFTAIN ST
LAS VEGAS NV
89117-6723
US

V. Phone/Fax

Practice location:
  • Phone: 702-885-5666
  • Fax:
Mailing address:
  • Phone: 702-885-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: