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General NPI Number Information
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NPI Number | 1124795299
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Entity Type | Individual
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Provider Name | BAOLONG VIET NGUYEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 8601 VILLAGE DR STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5509
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Country | US
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Telephone | 210-942-4217
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Fax | 830-626-7110
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Provider Business Mailing Address
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Address Line | 8601 VILLAGE DR STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78217-5509
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Country | US
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Telephone | 210-942-4217
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Fax | 210-538-2484
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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 | PA15028
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License Number State | TX
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