Provider Demographics
NPI:1750052304
Name:NGUYEN, DIEM MY
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:MY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 ARVIDSON CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4700
Mailing Address - Country:US
Mailing Address - Phone:909-644-2827
Mailing Address - Fax:
Practice Address - Street 1:1520 N MOUNTAIN AVE, SET 206
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-689-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst