Provider Demographics
NPI:1437814217
Name:NGUYEN, MICHELLE HOANG
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HOANG
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 1:6104 LOURDES TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3009
Mailing Address - Country:US
Mailing Address - Phone:619-453-8566
Mailing Address - Fax:
Practice Address - Street 1:9620 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1369
Practice Address - Country:US
Practice Address - Phone:858-505-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician