Healthcare Provider Details

I. General information

NPI: 1467159111
Provider Name (Legal Business Name): JEFFREY PHAM PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 E PALM CANYON DR
PALM SPRINGS CA
92264-1613
US

IV. Provider business mailing address

1775 E PALM CANYON DR STE 110
PALM SPRINGS CA
92264-1623
US

V. Phone/Fax

Practice location:
  • Phone: 760-627-9177
  • Fax:
Mailing address:
  • Phone: 760-627-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022483
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: