Healthcare Provider Details

I. General information

NPI: 1972626356
Provider Name (Legal Business Name): MYCHI PHAM EGGLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 VOLUNTEER LN
SACRAMENTO CA
95826
US

IV. Provider business mailing address

8912 VOLUNTEER LN
SACRAMENTO CA
95826-3221
US

V. Phone/Fax

Practice location:
  • Phone: 916-344-0199
  • Fax: 916-344-0196
Mailing address:
  • Phone: 916-344-0199
  • Fax: 916-344-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: