Healthcare Provider Details

I. General information

NPI: 1386839306
Provider Name (Legal Business Name): SALLY T PHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8368 ELK GROVE FLORIN RD
SACRAMENTO CA
95829-9228
US

IV. Provider business mailing address

PO BOX 255347
SACRAMENTO CA
95865-5347
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5547
  • Fax:
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP10835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: