Provider Demographics
NPI:1477141778
Name:NGUYEN, ALISON
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1920
Mailing Address - Country:US
Mailing Address - Phone:714-643-9012
Mailing Address - Fax:714-643-9015
Practice Address - Street 1:12665 GARDEN GROVE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1920
Practice Address - Country:US
Practice Address - Phone:714-643-9012
Practice Address - Fax:714-643-9015
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty