MEDICARE: DR. VANESSA L TSUDA-NGUYEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A8745	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A8745	OTHER	CA	CA MEDICAL LICENSE

General Provider Information

NPI Number	:	1184729048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA L TSUDA-NGUYEN D.O.

Provider Business Mailing Address
First Line	:	1104 CORPORATE WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3875
Country	:	US
Telephone Number	:	916-520-4466
Fax Number	:	877-585-0065

Provider Business Practice Location Address
First Line	:	1104 CORPORATE WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3875
Country	:	US
Telephone Number	:	916-520-4466
Fax Number	:	877-585-0065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	04/08/2013

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