Provider Demographics
NPI:1700248721
Name:NGUYEN, PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 S VICTORIA AVENUE
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6521
Mailing Address - Country:US
Mailing Address - Phone:805-351-0745
Mailing Address - Fax:805-288-6744
Practice Address - Street 1:1280 S VICTORIA AVENUE
Practice Address - Street 2:SUITE # 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6521
Practice Address - Country:US
Practice Address - Phone:805-351-0745
Practice Address - Fax:805-288-6744
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173034208100000X, 2081P2900X
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program