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General NPI Number Information
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NPI Number | 1598019135
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Entity Type | Individual
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Provider Name | TAMMY PHAM
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 9445 FARNHAM ST STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92123-1308
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Country | US
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Telephone | 858-380-4676
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Fax | 858-569-2418
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Provider Business Mailing Address
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Address Line | 4660 VIEWRIDGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92123-1638
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Country | US
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Telephone | 858-278-3292
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Fax | 858-278-3294
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW 33488
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | CA
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