| Southland Integrated Services, Inc. | |
|
9862 Chapman Ave Garden Grove CA 92841-2726 | |
| (714) 620-7001 | |
| (714) 620-7091 |
| Full Name | Southland Integrated Services, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 9862 Chapman Ave, Garden Grove, California |
| Authorized Official Name and Position | Tricia Thao Nguyen (CEO) |
| Authorized Official Contact | 7146207007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southland Integrated Services, Inc. 9862 Chapman Ave Garden Grove CA 92841-2726 Ph: (714) 620-7001 | Southland Integrated Services, Inc. 9862 Chapman Ave Garden Grove CA 92841-2726 Ph: (714) 620-7001 |
| NPI Number | 1285708818 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 02/05/2020 |
| Medicare PECOS PAC ID | 8921025438 |
|---|---|
| Medicare Enrollment ID | O20051024001144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285708818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Thuyanh Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609927722 PECOS PAC ID: 7618166950 Enrollment ID: I20110118000829 |
| Provider Name | Donny N Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649319666 PECOS PAC ID: 7214074954 Enrollment ID: I20150331000007 |
| Provider Name | Phuong Hoang Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851811301 PECOS PAC ID: 2769746155 Enrollment ID: I20180511000848 |
| Provider Name | Ngoc Nga Trinh Do |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972186179 PECOS PAC ID: 1153721451 Enrollment ID: I20210608001656 |
| Provider Name | Theresa Nguyen Tran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568939833 PECOS PAC ID: 1759783707 Enrollment ID: I20210713002480 |
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