Organization
PETER PHAM NURSING CORPORATION
Active
Other names
Black Onyx, Peter Pham Nursing Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
PETER PHAM NP (MR)
(714) 410-6588
Entity
Organization
Contact information
Practice address
1100 W TOWN AND COUNTRY RD STE 1239, ORANGE, CA 92868-4600
(714) 880-2791
(949) 229-0854
Mailing address
1100 W TOWN AND COUNTRY RD STE 1239, ORANGE, CA 92868-4600
(714) 880-2791
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104472174
—
CA
05
—
1366908543
—
CA
Enumeration date
03/16/2023
Last updated
11/17/2023
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