Provider Demographics
NPI:1265882856
Name:NGUYEN, ANH PHUONG (OT R/L)
Entity type:Individual
Prefix:
First Name:ANH
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 LANCEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4904
Mailing Address - Country:US
Mailing Address - Phone:760-218-1400
Mailing Address - Fax:714-775-8835
Practice Address - Street 1:15606 A BROOKHURST ST.
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-775-8875
Practice Address - Fax:714-775-8835
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist