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General NPI Number Information
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NPI Number | 1063109197
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Entity Type | Individual
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Provider Name | PATRICK NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 18225 BROOKHURST ST STE 6
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6719
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Country | US
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Telephone | 714-200-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 15901 PLUMWOOD ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-7283
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Country | US
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Telephone | 714-725-4432
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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 | PA62607
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License Number State | CA
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