Provider Demographics
NPI:1780189670
Name:NGUYEN, ANGIE SONGNGAN (NP)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:SONGNGAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23141 VERDUGO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1341
Mailing Address - Country:US
Mailing Address - Phone:949-215-5055
Mailing Address - Fax:949-215-5044
Practice Address - Street 1:1401 W 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:714-542-9708
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95008636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95008636OtherNURSE PRACTIONER