Provider Demographics
NPI:1336608819
Name:NGUYEN, MATHEW VINCENT
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:VINCENT
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 1:4460 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4010
Mailing Address - Country:US
Mailing Address - Phone:714-726-2914
Mailing Address - Fax:
Practice Address - Street 1:4460 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4010
Practice Address - Country:US
Practice Address - Phone:714-726-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator