Basic Information
| Provider Information | |||||||||
| NPI: | 1407037062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | LOAN ANH | ||||||||
| MiddleName: | THI | ||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 14180 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967811 | ||||||||
| FaxNumber: | 7148967808 | ||||||||
| Practice Location | |||||||||
| Address1: | 14180 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967811 | ||||||||
| FaxNumber: | 7148967808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2007 | ||||||||
| LastUpdateDate: | 11/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | RN458159 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.