Provider Demographics
NPI:1184204067
Name:PHAM, QUEENIE THUY (PA-C)
Entity type:Individual
Prefix:
First Name:QUEENIE
Middle Name:THUY
Last Name:PHAM
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11170 WARNER AVE # 417
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4013
Mailing Address - Country:US
Mailing Address - Phone:714-424-9300
Mailing Address - Fax:
Practice Address - Street 1:11170 WARNER AVE # 417
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4013
Practice Address - Country:US
Practice Address - Phone:714-424-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-11-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant