Healthcare Provider Details

I. General information

NPI: 1356339717
Provider Name (Legal Business Name): MARY SUZANNE NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MADRID ST
CASTROVILLE TX
78009-4527
US

IV. Provider business mailing address

409 MADRID ST PO BOX 960
CASTROVILLE TX
78009-4527
US

V. Phone/Fax

Practice location:
  • Phone: 830-538-2254
  • Fax: 830-931-2259
Mailing address:
  • Phone: 830-538-2254
  • Fax: 830-931-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK5365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: