MEDICARE: C NGUYEN MEDICAL MANAGEMENT INC

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	363LF0000X	Family Nurse Practitioner	646992	TX

General Provider Information

NPI Number	:	1659443190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C NGUYEN MEDICAL MANAGEMENT INC

Provider Business Mailing Address
First Line	:	723 SHOTWELL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4813
Country	:	US
Telephone Number	:	713-673-9400
Fax Number	:	713-673-9401

Provider Business Practice Location Address
First Line	:	723 SHOTWELL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4813
Country	:	US
Telephone Number	:	713-673-9400
Fax Number	:	713-673-9401

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITTIONER
Name	:	MRS. CHRISTINE NGUYEN-MOEN
Credential	:	C-FNP
Telephone Number	:	713-673-9400

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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