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NPI Code Detail

MEDICARE: TRACY PHAM RN

MEDICARE: TRACY PHAM RN
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
1163W00000XRegistered Nurse95041403CA

General Provider Information

NPI Number : 1437694627
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY PHAM RN
Provider Business Mailing Address
First Line : 9451 INDIANAPOLIS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-5955
Country : US
Telephone Number : 714-593-9630
Fax Number : 714-964-5321
Provider Business Practice Location Address
First Line : 9451 INDIANAPOLIS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-5955
Country : US
Telephone Number : 714-593-9630
Fax Number : 714-964-5321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2016
Last Update Date : 12/27/2016

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Directions to “ TRACY PHAM RN” Practice Location

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