Active NPI
Sidaphone Anna Phovixay, ASW61745
- Social Worker
- Stockton, CA
National Provider Identifier
1083747562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- ASW61745
- Practice address
- 2495 W March LN
Stockton, CA 95207-8251 - Phone
- (209) 465-1080
- NPI assigned
- Mar 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | ASW61745 | CA | Primary |
Addresses
Primary practice location
2495 W March LN
Stockton, CA 95207-8251
Mailing address
2495 W March LN
Stockton, CA 95207-8251
Phone (209) 465-1080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW61745 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425340800000",
"number": "1083747562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2495 W MARCH LN",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952078251",
"telephone_number": "209-465-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2495 W MARCH LN",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952078251",
"telephone_number": "209-465-1080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOVIXAY",
"first_name": "SIDAPHONE",
"middle_name": "ANNA",
"name_prefix": "Miss",
"credential": "ASW61745",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-13",
"last_updated": "2015-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "ASW61745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.