Individual ProviderStacie PhamStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address110 S Garfield Ave, Montebello, CA 90640-3810(323) 869-9255PECOS EnrollmentBased on the most recent information from CMS, provider Stacie Pham does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:14 PM.Profile DetailsProvider ID1497935282Provider TypeIndividualFull NamePham, StacieTitleMs.CredentialM.S.GenderFemaleSole ProprietorNoEnumeration Date11/8/2007Last Updated11/8/2007Contact InformationPractice LocationPractice Address110 S Garfield Ave, Montebello, CA 90640-3810Phone(323) 869-9255FaxUnlisted FaxMailing LocationMailing Address110 S Garfield Ave, Montebello, CA 90640-3810Phone(323) 869-9255FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer