Provider Demographics
NPI:1164576195
Name:LOR, PHA (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:PHA
Middle Name:
Last Name:LOR
Suffix:
Gender:M
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GOVERNORS LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1990
Mailing Address - Country:US
Mailing Address - Phone:530-267-1700
Mailing Address - Fax:
Practice Address - Street 1:7 GOVERNORS LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1990
Practice Address - Country:US
Practice Address - Phone:530-267-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator