Peter Pham Nursing Corporation

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PETER PHAM NURSING CORPORATION

Doing business as

Black Onyx

Practice address

1100 W Town and Country Rd Ste 1239
Orange, CA 92868-4600

Phone

(714) 880-2791

Fax

(949) 229-0854

NPI assigned

Mar 16, 2023

Last updated

Nov 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Peter Pham, NPNPI 1366908543

Title

Mr

Phone

(714) 410-6588

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Black Onyx Doing business as
• Peter Pham Nursing Corporation Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peter Pham, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange, CA
  • NPI 1366908543
  Authorized official Same address or phone
• Diana Bush, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange, CA
  • NPI 1104472174
  NPD

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1750082780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 W TOWN AND COUNTRY RD STE 1239",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684600",
            "telephone_number": "714-880-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W TOWN AND COUNTRY RD STE 1239",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684600",
            "telephone_number": "714-880-2791",
            "fax_number": "949-229-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER PHAM NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "MR",
        "authorized_official_telephone_number": "714-410-6588",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104472174",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366908543",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Onyx",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peter Pham Nursing Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Heather Perris, FNP-BC
• Alexis Perry
• Rachel Anne Perry, M.D.
• Luz Peru
• Peter G Geddes, M.D.
• Qetuwrah Mahla Peters
• Ayrton Petersen
• Brennan Peterson, PH.D., LMFT
• Brett M Peterson, MD
• Darcie Anne Peterson, NP

• Psychiatric/Mental Health Nurse Practitioner in Orange, CA
• Providers in Orange, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.