1508879313 NPI number — DR. DIEUTHOA TRUONGGIA PSY. D.

Table of content: DR. DIEUTHOA TRUONGGIA PSY. D. (NPI 1508879313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508879313 NPI number — DR. DIEUTHOA TRUONGGIA PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUONGGIA
Provider First Name:
DIEUTHOA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRUONGGIA
Provider Other First Name:
THOA
Provider Other Middle Name:
DIEU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY. D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508879313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11689 QUARTZ AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-1550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-552-6841
Provider Business Mailing Address Fax Number:
714-552-6841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 WARNER AVE
Provider Second Line Business Practice Location Address:
STE 101B
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-552-6841
Provider Business Practice Location Address Fax Number:
714-242-1991
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY18930 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY189300 . This is a "MEDICAL PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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