Provider Demographics
NPI:1144908203
Name:NGUYEN, MONGTHU
Entity type:Individual
Prefix:
First Name:MONGTHU
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SILAS
Other - Middle Name:KHAC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4885 COLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1830
Mailing Address - Country:US
Mailing Address - Phone:714-471-8494
Mailing Address - Fax:
Practice Address - Street 1:4885 COLE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-1830
Practice Address - Country:US
Practice Address - Phone:714-471-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician