Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT36022 | CA |
NPI | 1134426745 |
---|---|
Provider Name | Mrs. Thao Pham |
First Address | Santa Ana, CA 92701 |
Second Address | Santa Ana, CA 92701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 21/08/2020 |