Provider Demographics
NPI:1891265559
Name:NGUYEN, MARIA (COMMUNITY ADVOCATE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:COMMUNITY ADVOCATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 MCGIRK AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1823
Mailing Address - Country:US
Mailing Address - Phone:263-299-7336
Mailing Address - Fax:
Practice Address - Street 1:3424 WILSHIRE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:323-653-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician