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General NPI Number Information
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NPI Number | 1255149498
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Entity Type | Individual
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Provider Name | DEREK HUU NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 910 GRAND AVE STE 109
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City | SAN DIEGO
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State | CA
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Zip | 92109-4047
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Country | US
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Telephone | 858-283-8141
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Fax |
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Provider Business Mailing Address
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Address Line | 3895 CATAMARCA DR
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City | SAN DIEGO
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State | CA
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Zip | 92124-3403
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 306539
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License Number State | CA
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