MEDICARE: VICTORIA PHAM PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA13933	TX

General Provider Information

NPI Number	:	1104406073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA PHAM PA-C

Provider Business Mailing Address
First Line	:	1735 UNION ST BLDG A
Second Line	:
City	:	LEANDER
State	:	TX
Zip	:	78641-1201
Country	:	US
Telephone Number	:	512-986-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2818 KRAMER LN UNIT 4414
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-1013
Country	:	US
Telephone Number	:	832-490-8623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	06/06/2021

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