Mr. Phokham Mike Sourivanh, PA-C - Apo, AP

Mr. Phokham Mike Sourivanh, PA-C

Military Health Care Provider in Apo, N/A

NPI 1972022762

Phokham Mike Sourivanh is a Military Health Care Provider based in Apo, . Phokham Mike Sourivanh practices in Apo, and has the professional credentials of PA-C. The NPI Number for Phokham Mike Sourivanh is 1972022762 and holds a License No. (N/A).

The current practice location address for Phokham Mike Sourivanh is Camp Pendleton, Apo, and can be reached out via phone at 760-725-1288.

Location: Camp Pendleton, Apo, , 92055

NPI Number

1972022762

Provider Name

Phokham Mike Sourivanh

Credential

PA-C

Provider Entity Type

Individual

Gender

Male

Address

Camp Pendleton, Apo, , 92055

Phone Number

760-725-1288

Fax Number

Provider Enumeration Date

09/13/2017

Last Update Date

03/09/2024

Address

Camp Pendleton

City

Apo

State

Zip

92055

Phone Number

760-725-1288

Fax Number

Address

Camp Pendleton

City

Apo

State

Zip

92055

Phone Number

760-725-1288

Fax Number

Type

Other Service Providers

Classification

Military Health Care Provider

Speciality

Taxonomy

171000000X

License No.

()

Definition

Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.

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