Provider Demographics
NPI:1043502438
Name:PHAM, YVETTE ANN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:YVETTE
Middle Name:ANN
Last Name:PHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 TRAWOOD DR
Mailing Address - Street 2:SUITE B250-1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3322
Mailing Address - Country:US
Mailing Address - Phone:915-603-4102
Mailing Address - Fax:
Practice Address - Street 1:2150 TRAWOOD DR
Practice Address - Street 2:SUITE B250-1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3322
Practice Address - Country:US
Practice Address - Phone:915-603-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT 112783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist