MEDICARE: ETC CONSULTANTS 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	2084P0800X	Psychiatry Physician	A69542	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A69542	OTHER	CA	STATE LECENSE

General Provider Information

NPI Number	:	1891948717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETC CONSULTANTS INC

Provider Business Mailing Address
First Line	:	6 COLOMA
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-2438
Country	:	US
Telephone Number	:	949-689-9754
Fax Number	:	949-313-5078

Provider Business Practice Location Address
First Line	:	3151 AIRWAY AVE STE T3
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4627
Country	:	US
Telephone Number	:	949-689-9754
Fax Number	:	714-545-5748

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	DR. CHARLES TUAN-TU SONG NGUYEN
Credential	:	M.D.
Telephone Number	:	949-689-9754

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	02/23/2012

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Directions to “ETC CONSULTANTS INC ” Practice Location

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