Provider Demographics
NPI:1477344224
Name:NGUYEN, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 DREW CIR APT 2045
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7809
Mailing Address - Country:US
Mailing Address - Phone:714-823-0981
Mailing Address - Fax:
Practice Address - Street 1:2010A HARBISON DR STE 307
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3900
Practice Address - Country:US
Practice Address - Phone:714-823-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician