=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669039954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THANHVI NGUYEN DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2019
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20821 US HIGHWAY 281 N STE 122
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-7595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-546-1600
-----------------------------------------------------
Fax | 210-546-1610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2961 MOSSROCK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-731-4800
-----------------------------------------------------
Fax | 210-731-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | BP10068875
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | T0584
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------