Healthcare Provider Details

I. General information

NPI: 1740607472
Provider Name (Legal Business Name): AUDIOLOGY BY HOLLY NGUYEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 W TROPICANA AVE SUITE 249
LAS VEGAS NV
89103-4757
US

IV. Provider business mailing address

6787 W TROPICANA AVE SUITE 249
LAS VEGAS NV
89103-4757
US

V. Phone/Fax

Practice location:
  • Phone: 702-755-9597
  • Fax: 702-933-8688
Mailing address:
  • Phone: 702-755-9597
  • Fax: 702-933-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberA-245
License Number StateNV

VIII. Authorized Official

Name: DR. MAI LY THI HOLLY NGUYEN
Title or Position: OWNER
Credential: AU.D.
Phone: 702-755-9597