Individual provider Active NPI

Priscilla Nguyen

  • Physical Therapy Assistant
  • Huntington Beach, CA
National Provider Identifier
1699312231
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA49310 Issued in CA
Practice address
17122 Beach Blvd Ste 104
Huntington Beach, CA 92647-5992
Phone
(714) 964-4448
NPI assigned
Dec 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA49310 CA Primary

Addresses

Primary practice location

17122 Beach Blvd Ste 104
Huntington Beach, CA 92647-5992

Mailing address

14182 Lake St
Garden Grove, CA 92843-4809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA49310CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Agile Occupational Medicine, PC CurrentSince Jul 28, 2025 Accepting new patients
OBGYN Affiliates Medical Group PastSince Dec 9, 2019 Accepting new patients

Locations

17122 Beach Blvd
Ste 104
Huntington Beach, CA 92647
Phone (714) 964-4448

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575244800000",
    "number": "1699312231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14182 LAKE ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17122 BEACH BLVD STE 104",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475992",
            "telephone_number": "714-964-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "PRISCILLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2019-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "PTA49310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.