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General NPI Number Information
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NPI Number | 1407462526
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Entity Type | Individual
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Provider Name | TRACY THUY VU PA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 5800 JEFFERSON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3582
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Country | US
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Telephone | 505-828-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 23415 TIRINO SHORES DR
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City | KATY
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State | TX
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Zip | 77493-2853
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Country | US
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Telephone | 281-381-8483
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DT86638
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA2024-0111
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License Number State | NM
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