Healthcare Provider Details

I. General information

NPI: 1851701429
Provider Name (Legal Business Name): NGOC HAN THI PHAM DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 CHIQUITA BLVD S STE 200 # SW01
CAPE CORAL FL
33914-6324
US

IV. Provider business mailing address

PO BOX 390
ESTERO FL
33929-0390
US

V. Phone/Fax

Practice location:
  • Phone: 305-586-8502
  • Fax: 239-323-9933
Mailing address:
  • Phone: 305-586-8502
  • Fax: 239-323-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: