Provider Demographics
NPI:1891388708
Name:PHAM, JASMINE NGUYEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NGUYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9665 GENESEE AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1818
Mailing Address - Country:US
Mailing Address - Phone:408-203-6762
Mailing Address - Fax:
Practice Address - Street 1:9665 GENESEE AVE APT C2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1818
Practice Address - Country:US
Practice Address - Phone:408-203-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist