Provider Demographics
NPI:1922183250
Name:NGUYEN, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-613-8949
Mailing Address - Fax:858-613-8953
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-613-8949
Practice Address - Fax:858-613-8953
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA070498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA70498AMedicare ID - Type Unspecified
CAH86676Medicare UPIN