Healthcare Provider Details

I. General information

NPI: 1669293841
Provider Name (Legal Business Name): PHOENIX PHYSICIANS IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 S RICE AVE STE C
HOUSTON TX
77081-2944
US

IV. Provider business mailing address

6 VERANDA
NEWPORT COAST CA
92657-1632
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-8996
  • Fax:
Mailing address:
  • Phone: 818-399-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. LAN NHU BICH PHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-399-8996