MEDICARE: TRUC NGUYEN PA-C

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	363A00000X	Physician Assistant	7615	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306308465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRUC NGUYEN PA-C

Provider Business Mailing Address
First Line	:	5406 W GLENN DR STE 3
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2662
Country	:	US
Telephone Number	:	623-270-6336
Fax Number	:	623-283-4884

Provider Business Practice Location Address
First Line	:	5406 W GLENN DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-2662
Country	:	US
Telephone Number	:	623-270-6336
Fax Number	:	623-283-4884

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	04/21/2025

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Directions to “ TRUC NGUYEN PA-C” Practice Location

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