MEDICARE: TRACEY NGUYEN RD

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	133V00000X	Registered Dietitian	86064302	CA

General Provider Information

NPI Number	:	1295221794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY NGUYEN RD

Provider Business Mailing Address
First Line	:	1045 GARRITY WAY
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-4129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 GARRITY WAY
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-4129
Country	:	US
Telephone Number	:	408-881-2653
Fax Number	:

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

Provider Enumeration Date	:	07/08/2018
Last Update Date	:	01/03/2022

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