Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | B201805308 | VA |
NPI | 1174143580 |
---|---|
Provider Name | Calvin Nguyen |
First Address | Ashburn, VA 20147-4093 |
Second Address | Fairfax, VA 22035-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2020 |
Last Update Date | 26/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E3452375 | NREMT (01) | VA |