Provider Demographics
NPI:1790419521
Name:PHAM, KATHYRINA LUCY (NP)
Entity Type:Individual
Prefix:
First Name:KATHYRINA
Middle Name:LUCY
Last Name:PHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 KEENAN PL
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1972
Mailing Address - Country:US
Mailing Address - Phone:714-931-7791
Mailing Address - Fax:
Practice Address - Street 1:10780 KEENAN PL
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-1972
Practice Address - Country:US
Practice Address - Phone:714-931-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily