Healthcare Provider Details

I. General information

NPI: 1326835331
Provider Name (Legal Business Name): MINH PHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 BARTLETT ST NE STE 1B
ALBUQUERQUE NM
87109-5916
US

IV. Provider business mailing address

1855 SMARTY JONES ST SE
ALBUQUERQUE NM
87123-2398
US

V. Phone/Fax

Practice location:
  • Phone: 505-313-6732
  • Fax:
Mailing address:
  • Phone: 505-313-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: