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NPI Code Detail

MEDICARE: SHALLY LE PHAM OTD

MEDICARE: SHALLY LE PHAM OTD
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
1225X00000XOccupational Therapist28577CA

General Provider Information

NPI Number : 1487593026
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALLY LE PHAM OTD
Provider Business Mailing Address
First Line : 4463 MENTONE ST APT 2
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-1019
Country : US
Telephone Number : 757-401-3563
Fax Number :
Provider Business Practice Location Address
First Line : 3420 COLLEGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-7134
Country : US
Telephone Number : 619-515-2445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2026
Last Update Date : 03/31/2026

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Directions to “ SHALLY LE PHAM OTD” Practice Location

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