Provider Demographics
NPI:1114544574
Name:NGUYEN, SUZIE THI (BA)
Entity Type:Individual
Prefix:
First Name:SUZIE
Middle Name:THI
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 1:1509 W CAMERON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2725
Mailing Address - Country:US
Mailing Address - Phone:626-993-3000
Mailing Address - Fax:626-993-3086
Practice Address - Street 1:1509 W CAMERON AVE STE 230
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2725
Practice Address - Country:US
Practice Address - Phone:626-993-3000
Practice Address - Fax:626-993-3086
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2022-01-26
Deactivation Date:2022-01-03
Deactivation Code:
Reactivation Date:2022-01-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner