| NPI | 1386350734 |
|---|---|
| Doing Business As | PHOENIX MED IPA |
| Entity Type | Organization |
| Authorized Contact | LAN NHU BICH PHAN Administrator 818-399-8996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-01-30 |