Provider Demographics
NPI:1972000685
Name:NGUYEN, DIEM P (RDN)
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 MOONSEED LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7421
Mailing Address - Country:US
Mailing Address - Phone:818-274-2969
Mailing Address - Fax:
Practice Address - Street 1:1667 MOONSEED LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7421
Practice Address - Country:US
Practice Address - Phone:818-274-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86072366133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty