Provider Demographics
NPI:1245464106
Name:NGUYEN, ANN MARIE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N PACIFIC COAST HWY STE 1140
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4476
Mailing Address - Country:US
Mailing Address - Phone:310-926-4415
Mailing Address - Fax:
Practice Address - Street 1:390 N PACIFIC COAST HWY STE 1140
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4476
Practice Address - Country:US
Practice Address - Phone:310-926-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12983171100000X
CAND-349175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist