MEDICARE: AUDREY 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	225X00000X	Occupational Therapist	14290	CA

General Provider Information

NPI Number	:	1891107363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY NGUYEN

Provider Business Mailing Address
First Line	:	14966 TERRENO DE FLORES LN
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 OYSTER POINT BLVD
Second Line	:	STE 202
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1928
Country	:	US
Telephone Number	:	650-758-4700
Fax Number	:

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

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/19/2017

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Directions to “ AUDREY NGUYEN ” Practice Location

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