Provider Demographics
NPI:1821585795
Name:NGUYEN, PHUONG CELINE
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:CELINE
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 1:4973 E. ROSEMONTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-6153
Mailing Address - Country:US
Mailing Address - Phone:858-776-2502
Mailing Address - Fax:
Practice Address - Street 1:7000 E MAYO BLVD STE 1034
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-6153
Practice Address - Country:US
Practice Address - Phone:480-513-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty