Individual
VI T PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1080 CHINOOK LN, PUEBLO, CO 81001-1850
(719) 564-9400
(719) 564-0497
Mailing address
1080 CHINOOK LN, PUEBLO, CO 81001-1850
(719) 564-9400
(719) 564-0497
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0004927
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.0004927
DORA MEDICAL BOARD.
CO
Enumeration date
05/11/2017
Last updated
05/11/2017
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