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NPI Code Detail

MEDICARE: DIANA THAO PHAN SCM

MEDICARE: DIANA THAO PHAN SCM
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
1170300000XGenetic Counselor (M.S.)GC001226CA

General Provider Information

NPI Number : 1932738648
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA THAO PHAN SCM
Provider Business Mailing Address
First Line : 12903 STANDISH DR
Second Line :
City : POWAY
State : CA
Zip : 92064-5950
Country : US
Telephone Number : 858-231-3151
Fax Number :
Provider Business Practice Location Address
First Line : 3075 HEALTH CENTER DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-2773
Country : US
Telephone Number : 858-939-5218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2020
Last Update Date : 11/27/2023

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Directions to “ DIANA THAO PHAN SCM” Practice Location

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