Healthcare Provider Details

I. General information

NPI: 1235897281
Provider Name (Legal Business Name): LOUIS PHAM FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 N MOUNTAIN AVE STE A
UPLAND CA
91786-8516
US

IV. Provider business mailing address

9220 HAVEN AVE STE 120
RANCHO CUCAMONGA CA
91730-8551
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-4574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95242868
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: