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Organization

ETC CONSULTANTS INC

Active
Other names
Lorphen Medical
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHARLES TUAN-TU SONG NGUYEN M.D. (MEDICAL DIRECTOR/OWNER)
(949) 689-9754
Entity
Organization

Contact information

Practice address
3151 AIRWAY AVE STE T3, COSTA MESA, CA 92626-4627
(949) 689-9754
(714) 545-5748
Mailing address
6 COLOMA, IRVINE, CA 92602-2438
(949) 689-9754
(949) 313-5078

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A69542
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A69542
STATE LECENSE
CA
Enumeration date
10/23/2008
Last updated
02/23/2012
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