Provider Demographics
NPI:1811412687
Name:PHAM ACUPUNCTURE PROFESSIONAL CORPORATTION
Entity Type:Organization
Organization Name:PHAM ACUPUNCTURE PROFESSIONAL CORPORATTION
Other - Org Name:SANTA BARBARA HERB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:805-300-7465
Mailing Address - Street 1:895 FORTUNA LN
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4316
Mailing Address - Country:US
Mailing Address - Phone:805-300-7465
Mailing Address - Fax:
Practice Address - Street 1:3760 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3181
Practice Address - Country:US
Practice Address - Phone:805-563-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16361171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty