Provider Demographics
NPI:1649967183
Name:NGUYEN, DOMINIQUE THUY (RT (R)(M) ARRT)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RT (R)(M) ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 JADESTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2148
Mailing Address - Country:US
Mailing Address - Phone:805-813-2463
Mailing Address - Fax:
Practice Address - Street 1:2750 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1502
Practice Address - Country:US
Practice Address - Phone:805-955-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM000856982471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography