Organization
WARREN PHUC THAI MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCOUNTS MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
1800 SPRING RIDGE DR, SUSANVILLE, CA 96130-6100
(702) 453-3799
(702) 453-5741
Mailing address
PO BOX 33658, RENO, NV 89533-3658
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A108762
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13174
NV LIC
NV
01
—
A108762
CA LIC
CA
Enumeration date
01/06/2011
Last updated
01/06/2011
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