Provider Demographics
NPI:1821734427
Name:NGUYEN, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
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 1:13272 YOCKEY ST APT R
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2077
Mailing Address - Country:US
Mailing Address - Phone:714-600-9618
Mailing Address - Fax:
Practice Address - Street 1:20 SE 103RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2866
Practice Address - Country:US
Practice Address - Phone:503-496-5057
Practice Address - Fax:888-795-0947
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist