Provider Demographics
NPI:1780449926
Name:NGUYEN, STEPHANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 E 215TH PL
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-1603
Mailing Address - Country:US
Mailing Address - Phone:310-626-5163
Mailing Address - Fax:
Practice Address - Street 1:11586 COMPASS POINT DR N APT 68
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-8557
Practice Address - Country:US
Practice Address - Phone:310-626-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist