Provider Demographics
NPI:1093427452
Name:NGUYEN, JONATHAN TRUNG
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TRUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FULTON AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4299
Mailing Address - Country:US
Mailing Address - Phone:916-614-9539
Mailing Address - Fax:
Practice Address - Street 1:500 E ESPLANADE DR STE 600
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0525
Practice Address - Country:US
Practice Address - Phone:805-981-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN213760164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse