Provider Demographics
NPI:1043761430
Name:NGUYEN, VIET ANH (BCBA)
Entity Type:Individual
Prefix:
First Name:VIET
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 N HARBOR BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1350
Mailing Address - Country:US
Mailing Address - Phone:714-723-9649
Mailing Address - Fax:
Practice Address - Street 1:3303 HARBOR BLVD STE B9
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1517
Practice Address - Country:US
Practice Address - Phone:714-786-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-55465103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst