Basic Information
| Provider Information | |||||||||
| NPI: | 1932595220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | LYLEANNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13322 SANDRA PL | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928432712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143603559 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE | ||||||||
| Address2: | 9A | ||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906213341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
| FaxNumber: | 7145628729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95056697 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 95015250 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.