Healthcare Provider Details

I. General information

NPI: 1083277255
Provider Name (Legal Business Name): THY AI LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

IV. Provider business mailing address

550 W VISTA WAY STE 407
VISTA CA
92083-5714
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1092
  • Fax:
Mailing address:
  • Phone: 760-758-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016645
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95036841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: