Healthcare Provider Details

I. General information

NPI: 1568046274
Provider Name (Legal Business Name): BRIAN NGUYEN CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E 32ND ST
AUSTIN TX
78705-2703
US

IV. Provider business mailing address

339 CONSORT DR
BALLWIN MO
63011-4439
US

V. Phone/Fax

Practice location:
  • Phone: 512-476-7111
  • Fax:
Mailing address:
  • Phone: 636-386-9224
  • Fax: 636-200-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number32697857
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2021041104
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: