Provider Demographics
NPI:1992364210
Name:NGUYEN, VIET ANH
Entity type:Individual
Prefix:
First Name:VIET
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4997 BROOKHILL PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5911
Mailing Address - Country:US
Mailing Address - Phone:415-412-7516
Mailing Address - Fax:
Practice Address - Street 1:802 MAGNOLIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3144
Practice Address - Country:US
Practice Address - Phone:951-686-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2025-06-16
Deactivation Date:2023-07-03
Deactivation Code:
Reactivation Date:2025-06-16
Provider Licenses
StateLicense IDTaxonomies
CAY8797289106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician