Provider Demographics
NPI:1073907044
Name:PHAM, MAGGIE (DO)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:160 E ARTESIA ST STE 330
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2922
Mailing Address - Country:US
Mailing Address - Phone:909-622-5654
Mailing Address - Fax:909-622-4914
Practice Address - Street 1:160 E ARTESIA ST STE 330
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2922
Practice Address - Country:US
Practice Address - Phone:909-622-5654
Practice Address - Fax:909-622-4914
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A17125207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics