Provider Demographics
NPI:1861217713
Name:NGUYEN, ALEX (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13202 RANCHERO PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2117
Mailing Address - Country:US
Mailing Address - Phone:949-426-8524
Mailing Address - Fax:
Practice Address - Street 1:13202 RANCHERO PL
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2117
Practice Address - Country:US
Practice Address - Phone:949-426-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024069148363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health