Provider Demographics
NPI:1932965753
Name:PHAM, MADONNA MALINIS (FNP)
Entity Type:Individual
Prefix:
First Name:MADONNA
Middle Name:MALINIS
Last Name:PHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 MATTERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3522
Mailing Address - Country:US
Mailing Address - Phone:619-677-4418
Mailing Address - Fax:
Practice Address - Street 1:1819 MATTERO AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3522
Practice Address - Country:US
Practice Address - Phone:619-677-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily