Provider Demographics
NPI:1760674964
Name:NGUYEN TRUAX, FAYETTE KHUE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:FAYETTE
Middle Name:KHUE
Last Name:NGUYEN TRUAX
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36243 INLAND VALLEY DR STE 80
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9547
Mailing Address - Country:US
Mailing Address - Phone:951-813-3760
Mailing Address - Fax:
Practice Address - Street 1:36243 INLAND VALLEY DR STE 80
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9547
Practice Address - Country:US
Practice Address - Phone:951-813-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16134363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics