SONEPHET PHOMMARATH PSY.D, NPI 1063605715 — LOS ANGELES (CA)

NPI 1063605715

12+ Years Experience Individual

SONEPHET PHOMMARATH PSY.D

08/24/2007
PROVIDER ENUMERATION DATE
07/20/2011
LAST UPDATE DATE
1063605715
NPI NUMBER

About SONEPHET PHOMMARATH

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

SONEPHET PHOMMARATH is a provider established in LOS ANGELES, CA. The NPI number of SONEPHET PHOMMARATH is 1063605715 and was assigned on 08/24/2007. The practitioners primary taxonomy code is: 390200000X .

Mailing address

  • City: ALHAMBRA
  • State: CA
  • Postal code: 918038800
  • Address: 1000 S FREMONT AVE

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1063605715
  • Phone : 3239814318
  • Postalcode : 900405623
  • Address : 1500 S MCDONNELL AVE

Provider taxonomy - Student in an Organized Health Care Education/Training Program

  • Taxonomy code: 390200000X

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Contacts:

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  • SONEPHET PHOMMARATH PSY.D
  • Address : 1500 S MCDONNELL AVE
  • Region : LOS ANGELES, CA
  • NPI : 1063605715
  • Phone : 3239814318
  • Postalcode : 900405623

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1500 S MCDONNELL AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900405623
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3239814318
The telephone number associated with the location address of the provider being identified.
NPI1063605715
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1390200000X
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Provider Enumeration Date08/24/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07/20/2011
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)SONEPHET PHOMMARATH
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1000 S FREMONT AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameALHAMBRA
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code918038800
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Healthcare Provider Taxonomy Code #1390200000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Student in an Organized Health Care Education/Training Program
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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