Provider Demographics
NPI:1871015057
Name:NGUYEN, THERESA ANH THU
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANH THU
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 1:4053 CARRACCI LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1170
Mailing Address - Country:US
Mailing Address - Phone:408-621-4672
Mailing Address - Fax:
Practice Address - Street 1:1603A S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6261
Practice Address - Country:US
Practice Address - Phone:408-913-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician