MEDICARE: PHAMATECH INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	05D1078844	CA

General Provider Information

NPI Number	:	1023317781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHAMATECH INCORPORATED

Provider Business Mailing Address
First Line	:	15175 INNOVATION DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3401
Country	:	US
Telephone Number	:	858-643-5555
Fax Number	:	858-635-5843

Provider Business Practice Location Address
First Line	:	15175 INNOVATION DRIVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3401
Country	:	US
Telephone Number	:	858-643-5555
Fax Number	:	858-635-5843

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	TUAN H PHAM
Credential	:
Telephone Number	:	888-635-5840

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	04/17/2024

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