Provider Demographics
NPI:1366856940
Name:NGUYEN, KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 C ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5100
Mailing Address - Country:US
Mailing Address - Phone:619-550-3026
Mailing Address - Fax:619-238-4245
Practice Address - Street 1:427 C ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5100
Practice Address - Country:US
Practice Address - Phone:619-550-3026
Practice Address - Fax:619-238-4245
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse