Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A7978 | CA |
NPI | 1114033388 |
---|---|
Provider Name | Mrs. Stephanie Anh-Hang Nguyen |
First Address | Patton, CA 92369 |
Second Address | Patton, CA 92369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX79780 | (05) | CA |
I46165 | (02) | CA |