Provider Demographics
NPI:1548584618
Name:NGUYEN, AILEEN LIWANAG (CRNA)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:LIWANAG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:LIWANAG
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-256-4673
Practice Address - Fax:626-408-3911
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ081989367500000X
CANA4326367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered