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General NPI Number Information
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NPI Number | 1396079018
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Entity Type | Individual
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Provider Name | ANNIE BAO ANH TRUC NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 300 PULLMAN ST BLDG B
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City | LIVERMORE
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State | CA
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Zip | 94551-9756
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Country | US
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Telephone | 925-453-9554
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 ELEANOR LN
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City | MANTECA
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State | CA
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Zip | 95337-9644
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Country | US
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Telephone | 408-646-5393
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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