Provider Demographics
NPI:1962275909
Name:PHAM NEGRETE, VI T (PSYD)
Entity type:Individual
Prefix:DR
First Name:VI
Middle Name:T
Last Name:PHAM NEGRETE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 MAE ANNE AVE
Mailing Address - Street 2:STE 405, PMB 3035
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:909-235-9532
Mailing Address - Fax:
Practice Address - Street 1:680 E COLORADO BLVD STE 180&2ND
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-6143
Practice Address - Country:US
Practice Address - Phone:909-235-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026787390200000X
CAPSY34705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program