Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 326501 | CA |
NPI | 1194340661 |
---|---|
Provider Name | Mrs. Heather Lan-Phuong Nguyen |
First Address | Mission Viejo, CA 92691-8535 |
Second Address | Mission Viejo, CA 92691-6306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
326501 | ARRT (01) | CA |
76719 | RADIOLOGIC HEALTH BRANCH (01) | CA |