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General NPI Number Information
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NPI Number | 1659954303
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Entity Type | Individual
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Provider Name | LISA NGUYEN RDHAP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 413 LUCENT DR
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City | STANTON
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State | CA
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Zip | 90680-4024
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Country | US
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Telephone | 949-295-4704
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 W MOORE AVE
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City | SANTA ANA
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State | CA
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Zip | 92704-6131
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Country | US
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Telephone | 949-295-4704
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 27123
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP905
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License Number State | CA
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