Provider Demographics
NPI:1215363247
Name:NGUYEN, VAN QUOC (DPT)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-906-4623
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:1805 N SCOTTSDALE RD
Practice Address - Street 2:STE 2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1556
Practice Address - Country:US
Practice Address - Phone:480-941-4169
Practice Address - Fax:480-941-4972
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist