MEDICARE: ANNE QUYEN NGUYEN

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	363LG0600X	Gerontology Nurse Practitioner	NP 11007	CA

General Provider Information

NPI Number	:	1477630036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE QUYEN NGUYEN

Provider Business Mailing Address
First Line	:	10203 WINECREEK CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3728
Country	:	US
Telephone Number	:	714-470-0621
Fax Number	:

Provider Business Practice Location Address
First Line	:	10203 WINECREEK CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3728
Country	:	US
Telephone Number	:	714-470-0621
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/07/2023

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