Healthcare Provider Details

I. General information

NPI: 1255531687
Provider Name (Legal Business Name): MAILAN DINH PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N. PEPPER AVE ARMC BEHAVIORAL HEALTH
COLTON CA
92324
US

IV. Provider business mailing address

400 N. PEPPER AVE ARMC BEHAVIORAL HEALTH
COLTON CA
92324
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3830
  • Fax: 909-580-2165
Mailing address:
  • Phone: 909-580-3830
  • Fax: 909-580-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA95985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: