Michelle Theresa Petrillo Phan

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

1151 Dove St
Newport Beach, CA 92660-2840

Phone

(949) 630-8290

NPI assigned

Jan 16, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1033824974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 DOVE ST",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 DOVE ST",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602840",
            "telephone_number": "949-630-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLO PHAN",
        "first_name": "MICHELLE",
        "middle_name": "THERESA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2025-09-11",
        "certification_date": "2023-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Peterson
• Samuel R Peterson, MD
• John Francis Petraglia, M.D.
• Ryan Nicholas Petrecca
• Russell Sean Petrie, M.D.
• Babak Pezeshki, M.D.
• Chambrielle Thuy Pham, MFT
• David Q Pham, PHARM.D.
• Hali Hoang Pham, FNP
• Kathleen Pham, R.D.

• Behavior Analyst in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.