Provider Demographics
NPI:1508879313
Name:TRUONGGIA, DIEUTHOA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DIEUTHOA
Middle Name:
Last Name:TRUONGGIA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:THOA
Other - Middle Name:DIEU
Other - Last Name:TRUONGGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:11689 QUARTZ AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1550
Mailing Address - Country:US
Mailing Address - Phone:714-552-6841
Mailing Address - Fax:714-552-6841
Practice Address - Street 1:10900 WARNER AVE
Practice Address - Street 2:STE 101B
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-552-6841
Practice Address - Fax:714-242-1991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY189300OtherMEDICAL PROVIDER #
CAP88414Medicare UPIN
CACP18930AMedicare ID - Type Unspecified