Provider Demographics
NPI:1982577862
Name:PHAN, TAMMY MINH (RBT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MINH
Last Name:PHAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 STEMEL WAY
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4034
Mailing Address - Country:US
Mailing Address - Phone:408-242-3085
Mailing Address - Fax:
Practice Address - Street 1:400 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5106
Practice Address - Country:US
Practice Address - Phone:183-160-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician