Provider Demographics
NPI:1164982922
Name:NGUYEN, REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 LAS POSAS RD STE F100
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1428
Mailing Address - Country:US
Mailing Address - Phone:805-484-2813
Mailing Address - Fax:805-484-2316
Practice Address - Street 1:3615 LAS POSAS RD STE F100
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1428
Practice Address - Country:US
Practice Address - Phone:805-484-2813
Practice Address - Fax:805-484-2316
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191345207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology