Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A15108 | CA |
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A15108 | CA |
NPI | 1316333453 |
---|---|
Provider Name | Madeline Nguyen |
First Address | Marysville, CA 95901-4838 |
Second Address | Sacramento, CA 95811-6822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 17/09/2018 |