Provider Demographics
NPI:1639648983
Name:NGUYEN, SAMSON QUOC (RBT)
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OAK LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2629
Mailing Address - Country:US
Mailing Address - Phone:650-938-3600
Mailing Address - Fax:
Practice Address - Street 1:36 OAK LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2629
Practice Address - Country:US
Practice Address - Phone:650-938-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician