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NPI Code Detail

MEDICARE: SONEPHET PHOMMARATH PSY.D

MEDICARE: SONEPHET PHOMMARATH PSY.D
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063605715
Entity Type Code : Individual
Provider Name (Legal Business Name) : SONEPHET PHOMMARATH PSY.D
Provider Business Mailing Address
First Line : 1000 S FREMONT AVE
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-8800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MCDONNELL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90040-5623
Country : US
Telephone Number : 323-981-4318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2007
Last Update Date : 07/20/2011

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