Individual
JIMMY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
24422 AVENIDA DE LA CARLOTA STE 190, LAGUNA HILLS, CA 92653-3634
(949) 340-6927
Mailing address
24422 AVENIDA DE LA CARLOTA STE 190, LAGUNA HILLS, CA 92653-3634
(949) 340-6927
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT293952
CA
Other
Enumeration date
01/25/2017
Last updated
08/05/2019
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