| Theodore Thien Phan, | |
|
52 Trinity Dr, Novato, CA 94947-5246 | |
| (415) 320-2313 | |
| Not Available |
| Full Name | Theodore Thien Phan |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 52 Trinity Dr, Novato, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104546969 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 61808 (California) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (NU) | Secondary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore Thien Phan, 52 Trinity Dr, Novato, CA 94947-5246 Ph: (415) 320-2313 | Theodore Thien Phan, 52 Trinity Dr, Novato, CA 94947-5246 Ph: (415) 320-2313 |
Ms. Darcie Ann Larimore-arenas, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 300 Professional Center Dr Ste 326, Novato, CA 94947 Phone: 415-897-5400 Fax: 415-892-9506 |
Mollie Moore, PA-C, MSPAS, MPH Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 5800 Nave Dr Ste F, Novato, CA 94949 Phone: 415-483-4807 |
Kimya Baradaran, Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 75 Rowland Way Ste 250, Novato, CA 94945 Phone: 415-927-0666 |
Michele Jodoin, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 165 Rowland Blvd, 215, Novato, CA 94945 Phone: 415-897-5171 Fax: 415-892-1611 |
Rhiarose Magbitang Dec, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 7100 Redwood Blvd, Suite 200, Novato, CA 94945 Phone: 858-361-1441 |
Mark Larroque, P.A. Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 275 San Carlos Way, Novato, CA 94945 Phone: 415-246-7727 |
Michael David Romero, Physician Assistant Medicare: Medicare Enrolled Practice Location: 100 Rowland Way Ste 300, Novato, CA 94945 Phone: 415-878-0225 Fax: 415-878-0215 |