Healthcare Provider Details

I. General information

NPI: 1548638406
Provider Name (Legal Business Name): PACIFIC WOMEN'S HEALTHCARE ASSOCIAES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE SUITE 310
NEWPORT BEACH CA
92663-3657
US

IV. Provider business mailing address

500 SUPERIOR AVE SUITE 310
NEWPORT BEACH CA
92663-3657
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-7100
  • Fax:
Mailing address:
  • Phone: 949-650-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number383408
License Number StateCA

VIII. Authorized Official

Name: MR. NINO PHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-760-9316