Healthcare Provider Details

I. General information

NPI: 1962275909
Provider Name (Legal Business Name): VI T PHAM NEGRETE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

IV. Provider business mailing address

5150 MAE ANNE AVE STE 405, PMB 3035
RENO NV
89523
US

V. Phone/Fax

Practice location:
  • Phone: 909-235-9532
  • Fax:
Mailing address:
  • Phone: 909-235-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number94026787
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: