Provider Demographics
NPI:1467783043
Name:NGUYEN, BRIAN A (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24845 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6451
Mailing Address - Country:US
Mailing Address - Phone:310-463-5263
Mailing Address - Fax:
Practice Address - Street 1:24845 CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6451
Practice Address - Country:US
Practice Address - Phone:310-463-5263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0600020612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer