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NPI Code Detail

MEDICARE: TINA PHAN

MEDICARE: TINA PHAN
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
1103K00000XBehavior Analyst1-25-80555CA

General Provider Information

NPI Number : 1962242743
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA PHAN
Provider Business Mailing Address
First Line : 577 SALMAR AVE
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1453
Country : US
Telephone Number : 669-242-5090
Fax Number :
Provider Business Practice Location Address
First Line : 577 SALMAR AVE
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1453
Country : US
Telephone Number : 669-242-5090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2024
Last Update Date : 09/12/2025

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Directions to “ TINA PHAN ” Practice Location

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