Individual
COURTNEY PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10720 HATCH DR NW, ALBUQUERQUE, NM 87114-5779
(505) 917-9623
Mailing address
10720 HATCH DR NW, ALBUQUERQUE, NM 87114-5779
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
04/01/2014
Last updated
05/02/2016
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