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NICOLE PHAM
NPI 1083289649
Podiatrist - Foot & Ankle Surgery in Manteca, CA

Active since May 25, 2021PECOS Enrolled
1140 NORMAN DR STE 1, MANTECA, CA 95336(209) 823-2700 Get Directions Write a Review

NPPES record last updated: November 5, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 5, 2025, May 21, 2025, May 25, 2021 (3 updates tracked since 2021).

About Nicole Pham NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE PHAM (NPI 1083289649) is an individual foot & ankle surgery provider in Manteca, California, licensed in California (E6082) and active in the NPI registry since May 2021. She is enrolled in Medicare PECOS and is a graduate of California School Of Podiatric Medicine (2022).

NPPES Registry Identity

NPI1083289649
Entity TypeIndividualFemale
Primary Taxonomy213ES0103X
Provider Legal NameNICOLE PHAM
Location Address1140 NORMAN DR STE 1Manteca, CA 95336-5900
Mailing Address1140 Norman Dr Ste 1Manteca, CA 95336-5900
Phone(209) 823-2700
Sole ProprietorYes
Medical School CMSCalifornia School Of Podiatric MedicineGraduated 2022
Enumeration DateMay 25, 2021
Last NPPES UpdateNovember 5, 20253 updates tracked since enumeration
NPPES CertifiedNovember 5, 2025
✔ NPI 1083289649 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in CA · E6082
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1140 NORMAN DR STE 1, Manteca, CA 95336
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Pham is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7214431279
PECOS Enrollment IDI20250922002051
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE PHAM DPM PROFESSIONAL CORPORATION
Podiatrist
1140 NORMAN DR STE 1
MANTECA, CA 95336
San Joaquin County (209) 823-2700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Pham's NPI number?

The NPI number for Nicole Pham is 1083289649. It was assigned to this individual provider in the NPPES registry on May 25, 2021.

Where is Nicole Pham located?

Nicole Pham practices at 1140 Norman Dr Ste 1, Manteca, CA 95336. The listed phone number is (209) 823-2700.

What is Nicole Pham's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Nicole Pham enrolled in Medicare?

Yes. Nicole Pham is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nicole Pham was last updated on November 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.