Healthcare Provider Details

I. General information

NPI: 1821608811
Provider Name (Legal Business Name): TAMMY V PHAM, M.D., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

14396 GARDEN TRL
SAN DIEGO CA
92127-3613
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-9936
  • Fax:
Mailing address:
  • Phone: 619-334-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBYN ROSARIO
Title or Position: MANAGER
Credential:
Phone: 619-334-9936