Provider Demographics
NPI:1245755248
Name:NGUYEN, MICHAEL DINH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 E GUASTI RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1235
Mailing Address - Country:US
Mailing Address - Phone:626-406-0687
Mailing Address - Fax:
Practice Address - Street 1:3257 E GUASTI RD STE 210
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1235
Practice Address - Country:US
Practice Address - Phone:626-406-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-17-26675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst