Provider Demographics
NPI:1639121379
Name:NGUYEN, QUOC (MD)
Entity Type:Individual
Prefix:
First Name:QUOC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44605 AVENIDA DE MISSIONES STE 206
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5001
Mailing Address - Country:US
Mailing Address - Phone:951-200-5154
Mailing Address - Fax:951-302-0800
Practice Address - Street 1:44605 AVENIDA DE MISSIONES STE 206
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5001
Practice Address - Country:US
Practice Address - Phone:951-200-5154
Practice Address - Fax:951-302-0800
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA675162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A675161Medicare ID - Type Unspecified
H33068Medicare UPIN