Provider Demographics
NPI:1659783751
Name:PHAM, IRENE REYES ESTEVES (RDH, MPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:REYES ESTEVES
Last Name:PHAM
Suffix:
Gender:F
Credentials:RDH, MPH
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:REYES
Other - Last Name:ESTEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 CANADA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:408-595-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25383124Q00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No124Q00000XDental ProvidersDental Hygienist