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General NPI Number Information
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NPI Number | 1164817037
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Entity Type | Individual
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Provider Name | TIFFANY PHAM
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Gender | Female
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 445 S FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90071-1602
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Country | US
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Telephone | 887-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 2185 W GRANT LINE RD # 220
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City | TRACY
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State | CA
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Zip | 95377-7309
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Country | US
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Telephone | 92-839-3200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A146288
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License Number State | CA
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