Provider Demographics
NPI:1881353548
Name:NGUYEN, QUOC VIET
Entity type:Individual
Prefix:
First Name:QUOC
Middle Name:VIET
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 1:4375 BENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3013
Mailing Address - Country:US
Mailing Address - Phone:858-776-0517
Mailing Address - Fax:
Practice Address - Street 1:7614 LEMON AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1619
Practice Address - Country:US
Practice Address - Phone:619-303-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065-4627-5586146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1065-4627-5586OtherNATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIAN