Provider Demographics
NPI:1588258297
Name:NGUYEN, BAO TRAN N
Entity type:Individual
Prefix:
First Name:BAO TRAN
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 SOUTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4240
Mailing Address - Country:US
Mailing Address - Phone:408-464-0381
Mailing Address - Fax:
Practice Address - Street 1:4080 SOUTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4240
Practice Address - Country:US
Practice Address - Phone:408-464-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program