Provider Demographics
NPI:1750114328
Name:NGUYEN, JERRY HONG (CRNA)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:HONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7952 CARLYLE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6131
Mailing Address - Country:US
Mailing Address - Phone:951-756-0548
Mailing Address - Fax:
Practice Address - Street 1:9479 N FORT WASHINGTON RD STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5939
Practice Address - Country:US
Practice Address - Phone:559-289-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002433367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered