Provider Demographics
NPI:1013030063
Name:NGUYEN, NUONG T (BA)
Entity Type:Individual
Prefix:
First Name:NUONG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 DISA ALPINE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3271
Mailing Address - Country:US
Mailing Address - Phone:916-609-4933
Mailing Address - Fax:916-609-5160
Practice Address - Street 1:8654 DISA ALPINE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3271
Practice Address - Country:US
Practice Address - Phone:916-609-4933
Practice Address - Fax:916-609-5160
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4247Medicare UPIN