Healthcare Provider Details

I. General information

NPI: 1306389440
Provider Name (Legal Business Name): NHI PHAM NGUYEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17732 BEACH BLVD., SUITE G
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

17732 BEACH BLVD., SUITE G
HUNTINGTON BEACH CA
92647-7807
US

V. Phone/Fax

Practice location:
  • Phone: 714-655-7142
  • Fax: 833-224-5825
Mailing address:
  • Phone: 714-655-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19111
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: