Healthcare Provider Details

I. General information

NPI: 1124206453
Provider Name (Legal Business Name): MYHANH PHAM NGUYEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANH THI PHAM

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 01/11/2022
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 LA CASA VIA STE 120
WALNUT CREEK CA
94598-3019
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 925-941-4049
  • Fax:
Mailing address:
  • Phone: 925-952-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: