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General NPI Number Information
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NPI Number | 1033745468
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Entity Type | Individual
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Provider Name | JACQUELINE NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 350 WALTERS RD
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City | SUISUN CITY
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State | CA
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Zip | 94585-3043
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Country | US
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Telephone | 510-854-9876
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Fax |
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Provider Business Mailing Address
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Address Line | 350 WALTERS RD
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City | SUISUN CITY
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State | CA
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Zip | 94585-3043
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Country | US
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Telephone | 707-234-5564
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Fax | 707-666-6070
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34551
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License Number State | CA
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