Healthcare Provider Details

I. General information

NPI: 1487386017
Provider Name (Legal Business Name): DOLLY PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E COLORADO BLVD STE 120
PASADENA CA
91101-6800
US

IV. Provider business mailing address

600 E COLORADO BLVD STE 120
PASADENA CA
91101-6800
US

V. Phone/Fax

Practice location:
  • Phone: 323-301-7988
  • Fax:
Mailing address:
  • Phone: 510-495-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: