Provider Demographics
NPI:1609673342
Name:PHU, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PHU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E KATELLA AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5982
Mailing Address - Country:US
Mailing Address - Phone:888-725-7087
Mailing Address - Fax:
Practice Address - Street 1:2401 E KATELLA AVE STE 440
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5982
Practice Address - Country:US
Practice Address - Phone:888-725-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician