Provider Demographics
NPI:1174143580
Name:NGUYEN, CALVIN (EMT)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42785 GENERATION DR APT 601
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4093
Mailing Address - Country:US
Mailing Address - Phone:571-242-2931
Mailing Address - Fax:
Practice Address - Street 1:12099 GOVERNMENT CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22035-5501
Practice Address - Country:US
Practice Address - Phone:571-242-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB201805308207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE3452375OtherNREMT