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General NPI Number Information
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NPI Number | 1316493125
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Entity Type | Organization
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Legal Business Name | PHAMILY LOVE FOUNDATION
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 611 WILSHIRE BLVD STE 1002
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City | LOS ANGELES
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State | CA
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Zip | 90017-2906
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Country | US
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Telephone | 949-331-4559
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Fax | 844-522-5042
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Provider Business Mailing Address
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Address Line | 611 WILSHIRE BLVD STE 1002
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City | LOS ANGELES
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State | CA
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Zip | 90017-2906
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Country | US
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Telephone | 949-331-4559
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Fax | 844-522-5042
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAELYN T PHAM
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Credential |
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Telephone | 949-331-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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