Individual
BAO PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2335 CHATSWORTH BLVD, SAN DIEGO, CA 92106-1646
(202) 603-4768
(202) 603-4768
Mailing address
4205 45TH ST APT 1, SAN DIEGO, CA 92115-4808
(202) 603-4768
(202) 603-4768
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2023
Last updated
12/28/2023
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