Provider Demographics
NPI:1346998606
Name:NGUYEN, ELLEN XUAN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:XUAN
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 1:24902 SUNSET PL E
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4902
Mailing Address - Country:US
Mailing Address - Phone:714-251-9177
Mailing Address - Fax:
Practice Address - Street 1:24902 SUNSET PL E
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4902
Practice Address - Country:US
Practice Address - Phone:714-251-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician