MR. Phokham Mike Sourivanh, PA-C is a military health care provider in Apo, AP. The provider is active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. MR. Phokham Mike Sourivanh, PA-C NPI is 1972022762. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
CAMP PENDLETON
APO, AP
ZIP 92055
Phone: (760) 725-1288
The enumeration date for this NPI number is 9/13/2017 and was last updated on 4/21/2022.