Provider Demographics
NPI:1588224372
Name:NGUYEN, CRYSTAL THU (OTR)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16708 SAMPAN CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1654
Mailing Address - Country:US
Mailing Address - Phone:562-677-6457
Mailing Address - Fax:
Practice Address - Street 1:16708 SAMPAN CIR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1654
Practice Address - Country:US
Practice Address - Phone:562-677-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty