Provider Demographics
NPI:1396533261
Name:PHAM, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANH-THU
Other - Middle Name:ANNE
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1070 QUARTERMASTER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4845
Mailing Address - Country:US
Mailing Address - Phone:925-660-9902
Mailing Address - Fax:
Practice Address - Street 1:1070 QUARTERMASTER CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4845
Practice Address - Country:US
Practice Address - Phone:925-660-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist