Individual
NICOLE PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1140 NORMAN DR STE 1, MANTECA, CA 95336-5900
(209) 823-2700
Mailing address
1140 NORMAN DR STE 1, MANTECA, CA 95336-5900
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E6082
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2021
Last updated
11/05/2025
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