MEDICARE: PTN LLC

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1366905663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PTN LLC

Provider Business Mailing Address
First Line	:	17155 NEWHOPE ST STE P
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4233
Country	:	US
Telephone Number	:	714-757-0468
Fax Number	:

Provider Business Practice Location Address
First Line	:	17155 NEWHOPE ST STE P
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4233
Country	:	US
Telephone Number	:	714-757-0468
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THO NGOC PHAM
Credential	:
Telephone Number	:	714-757-0468

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	04/12/2019

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