Provider Demographics
NPI:1871478784
Name:PHAM, PAUL ANH (EDS, PPS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:EDS, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 MOUNT ALIFAN DR BLDG 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2615
Mailing Address - Country:US
Mailing Address - Phone:619-468-2936
Mailing Address - Fax:619-510-4626
Practice Address - Street 1:5331 MOUNT ALIFAN DR BLDG 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2615
Practice Address - Country:US
Practice Address - Phone:619-468-2936
Practice Address - Fax:619-510-4626
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240092495103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool