Provider Demographics
NPI:1861754079
Name:NGUYEN, DREW ANH (BCBA)
Entity type:Individual
Prefix:MR
First Name:DREW
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 17TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8522
Mailing Address - Country:US
Mailing Address - Phone:714-292-9415
Mailing Address - Fax:714-834-9822
Practice Address - Street 1:1525 E 17TH ST STE F
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8522
Practice Address - Country:US
Practice Address - Phone:714-292-9415
Practice Address - Fax:714-834-9822
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1084624103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst