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General NPI Number Information
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NPI Number | 1962692848
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Entity Type | Individual
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Provider Name | LILY DIEP NGOC NGUYEN MSPAS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 2330 GUS THOMASSON RD.
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City | DALLAS
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State | TX
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Zip | 75228
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Country | US
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Telephone | 972-349-6090
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Fax | 210-314-5044
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Provider Business Mailing Address
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Address Line | 14100 SAN PEDRO AVE STE 412
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2009
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Country | US
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Telephone | 210-281-8669
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Fax | 210-314-5044
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA08791
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License Number State | TX
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