Provider Demographics
NPI:1891865747
Name:LA, PHUONG ANH THI (PA-C)
Entity Type:Individual
Prefix:
First Name:PHUONG ANH
Middle Name:THI
Last Name:LA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:8815 E FALLBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-3601
Mailing Address - Country:US
Mailing Address - Phone:714-281-9277
Mailing Address - Fax:
Practice Address - Street 1:2071 COMPTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7278
Practice Address - Country:US
Practice Address - Phone:951-549-0900
Practice Address - Fax:951-278-8552
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical