Individual
AI (THERESA) DIEM NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6945 EL CAJON BLVD, SAN DIEGO, CA 92115-1754
(619) 697-4600
(619) 464-5526
Mailing address
6945 EL CAJON BLVD, SAN DIEGO, CA 92115-1754
(619) 697-4600
(619) 464-5526
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT11481
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0052930
—
CA
01
—
OPT11481
STATE LICENSE NUMBER
CA
Enumeration date
10/31/2005
Last updated
02/28/2013
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