Provider Demographics
NPI:1104502814
Name:NGUYEN, ANLANH-JENNIFER (PA-C)
Entity type:Individual
Prefix:
First Name:ANLANH-JENNIFER
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27B LOS COYOTES DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4711
Mailing Address - Country:US
Mailing Address - Phone:909-538-9052
Mailing Address - Fax:
Practice Address - Street 1:901 SAN BERNARDINO RD STE 102
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4988
Practice Address - Country:US
Practice Address - Phone:909-579-6721
Practice Address - Fax:909-579-6737
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65643363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical