MEDICARE: GIA UYEN T DIEP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator	NV
2	251S00000X	Community/Behavioral Health Agency	NV
3	374700000X	Technician	NV
4	103K00000X	Behavior Analyst

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	:	1437783537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIA UYEN T DIEP

Provider Business Mailing Address
First Line	:	3492 S CHIEFTAIN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6723
Country	:	US
Telephone Number	:	702-885-5666
Fax Number	:

Provider Business Practice Location Address
First Line	:	3492 S CHIEFTAIN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6723
Country	:	US
Telephone Number	:	702-885-5666
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	08/13/2020

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