Healthcare Provider Details

I. General information

NPI: 1124951488
Provider Name (Legal Business Name): TRUC THUY PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WASHINGTON ST
SAN DIEGO CA
92103-2289
US

IV. Provider business mailing address

PO BOX 542
BONITA CA
91908-0542
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-8300
  • Fax:
Mailing address:
  • Phone: 512-758-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: