Provider Demographics
NPI:1659714533
Name:NGUYEN, THO THI (DPM)
Entity Type:Individual
Prefix:
First Name:THO
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35633 CAPISTRANO ST
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-6943
Mailing Address - Country:US
Mailing Address - Phone:831-240-9305
Mailing Address - Fax:
Practice Address - Street 1:24640 JEFFERSON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9026
Practice Address - Country:US
Practice Address - Phone:951-677-1323
Practice Address - Fax:951-239-4233
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5273213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery