Healthcare Provider Details

I. General information

NPI: 1124855275
Provider Name (Legal Business Name): STEPHANIE PHU PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N MAGNOLIA AVE
ANAHEIM CA
92801-2604
US

IV. Provider business mailing address

4350 US-421
LILLINGTON NC
27546
US

V. Phone/Fax

Practice location:
  • Phone: 714-798-9044
  • Fax:
Mailing address:
  • Phone: 910-893-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: