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General NPI Number Information
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NPI Number | 1467159111
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Entity Type | Individual
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Provider Name | JEFFREY PHAM PMHNP
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1775 E PALM CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1613
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Country | US
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Telephone | 760-627-9177
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 E PALM CANYON DR STE 110
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City | PALM SPRINGS
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State | CA
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Zip | 92264-1623
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Country | US
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Telephone | 760-627-9177
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95022483
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 101084
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License Number State | CA
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