Provider Demographics
NPI:1932689825
Name:NGUYEN, CLAIRE WOMACK (PT)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:WOMACK
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16847 SCIOTO PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1225
Mailing Address - Country:US
Mailing Address - Phone:678-230-3600
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST STE 450
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0093
Practice Address - Country:US
Practice Address - Phone:213-740-0215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist