Active NPI
Lilie Mytrang Pham, DNP, FNP-C
- Family Nurse Practitioner
- Santa Cruz, CA
National Provider Identifier
1144504317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95008298
- Practice address
- 115A Coral St
Santa Cruz, CA 95060-2131 - Phone
- (831) 454-2080
- NPI assigned
- Oct 5, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95008298 | CA | Primary |
Addresses
Primary practice location
115A Coral St
Santa Cruz, CA 95060-2131
Mailing address
1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone (402) 201-5146
Other practice location 1
1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone (831) 454-4100
Other names 1
- Mytrang Thi Nguyen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95008298 | CA | MD | Family Nurse Practitioner |
Interoperability endpoints
- lpham299108@direct.ochin.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Watsonville, CA
- NPI 1770709149
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1144504317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1080 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601966",
"telephone_number": "402-201-5146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115A CORAL ST",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950602131",
"telephone_number": "831-454-2080"
}
],
"practiceLocations": [
{
"address_1": "1080 Emeline Ave",
"address_purpose": "LOCATION",
"city": "Santa Cruz",
"state": "CA",
"postal_code": "950601966",
"country_code": "US",
"telephone_number": "831-454-4100",
"fax_number": "831-454-4488",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHAM",
"first_name": "LILIE",
"middle_name": "MYTRANG",
"credential": "DNP, FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-05",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95008298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MYTRANG",
"last_name": "NGUYEN",
"middle_name": "THI",
"credential": "RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.