Provider Demographics
NPI:1346972494
Name:NGUYEN, ANGELINA T
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 CONTINENTAL WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8930
Mailing Address - Country:US
Mailing Address - Phone:209-954-6181
Mailing Address - Fax:
Practice Address - Street 1:4416 CONTINENTAL WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8930
Practice Address - Country:US
Practice Address - Phone:209-954-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician