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General NPI Number Information
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NPI Number | 1871400200
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Entity Type | Individual
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Provider Name | NICHOLAS BAO NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1431 GREENWAY DR STE 500
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City | IRVING
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State | TX
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Zip | 75038-2444
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Country | US
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Telephone | 214-467-9787
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 CRICKLEWOOD LN
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City | SPRING
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State | TX
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Zip | 77379-3653
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Country | US
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Telephone | 832-302-0624
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 219291
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License Number State | TX
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