MEDICARE: JERRY HONG NGUYEN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	95002433	CA

General Provider Information

NPI Number	:	1750114328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY HONG NGUYEN CRNA

Provider Business Mailing Address
First Line	:	7952 CARLYLE DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-6131
Country	:	US
Telephone Number	:	951-756-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	9479 N FORT WASHINGTON RD STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-5939
Country	:	US
Telephone Number	:	559-289-4574
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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