Provider Demographics
NPI:1275048852
Name:NGUYEN, PHUOC (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:PHUOC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S VALLEY PKWY APT 3207
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2056
Mailing Address - Country:US
Mailing Address - Phone:850-341-1555
Mailing Address - Fax:
Practice Address - Street 1:1721 W PLANO PKWY STE 212
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:469-931-2177
Practice Address - Fax:469-209-6076
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1773222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist