Healthcare Provider Details

I. General information

NPI: 1891865747
Provider Name (Legal Business Name): PHUONG ANH THI LA P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE LA P.A.-C

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 HARBOR BLVD STE 100
COSTA MESA CA
92627-9384
US

IV. Provider business mailing address

2077 HARBOR BLVD STE 100
COSTA MESA CA
92627-9384
US

V. Phone/Fax

Practice location:
  • Phone: 949-740-7117
  • Fax: 949-209-3955
Mailing address:
  • Phone: 949-740-7117
  • Fax: 949-209-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: