Provider Demographics
NPI:1962031294
Name:PHAM, CECILIA T (DO)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:T
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2139
Mailing Address - Country:US
Mailing Address - Phone:509-626-9900
Mailing Address - Fax:
Practice Address - Street 1:1190 BAKER ST STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4105
Practice Address - Country:US
Practice Address - Phone:949-791-3250
Practice Address - Fax:949-791-3261
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A21614207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program