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General NPI Number Information
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NPI Number | 1396239075
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Entity Type | Individual
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Provider Name | LARRY DO NGUYEN PT
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 4647 ZION AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 415-600-6680
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Fax |
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Provider Business Mailing Address
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Address Line | 11509 ROCOSO RD
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City | LAKESIDE
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State | CA
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Zip | 92040-1242
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Country | US
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Telephone | 916-690-2417
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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 | 37957
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License Number State | CA
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