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General NPI Number Information
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NPI Number | 1003421975
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Entity Type | Individual
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Provider Name | MIRANDA MINH-HAN NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 4000 CIVIC CENTER DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-4171
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Country | US
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Telephone | 415-492-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 FULTON ST APT 1
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-3450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 60845
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License Number State | CA
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