MEDICARE: CARL PHILLIPS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1275981409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL PHILLIPS JR.

Provider Business Mailing Address
First Line	:	4808 KANOB CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95842-2334
Country	:	US
Telephone Number	:	562-547-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 PEPPER OAKS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827
Country	:	US
Telephone Number	:	562-547-1502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	03/30/2026

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