Individual
LONG PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7175 ENCLAVE DR, EASTVALE, CA 92880-3828
(318) 791-9853
Mailing address
7175 ENCLAVE DR, EASTVALE, CA 92880-3828
(318) 791-9853
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
29433
CA
Other
Enumeration date
09/24/2018
Last updated
09/24/2018
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