=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528760873
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELLEN NGUYEN-PHAM PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 04/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8906 PERRIN BEITEL RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-572-3306
-----------------------------------------------------
Fax | 210-249-0125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2961 MOSSROCK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-731-4800
-----------------------------------------------------
Fax | 210-731-4810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------