Healthcare Provider Details

I. General information

NPI: 1417743261
Provider Name (Legal Business Name): JOANNA HA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9781 BLUE LARKSPUR LN STE 100
MONTEREY CA
93940-6509
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE # MC-4
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-9008
  • Fax: 831-333-9010
Mailing address:
  • Phone: 518-262-5251
  • Fax: 518-262-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: