Healthcare Provider Details

I. General information

NPI: 1437785342
Provider Name (Legal Business Name): PHYLICIA RAQUEL HAMMONDS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 109
BEVERLY HILLS CA
90211-2286
US

IV. Provider business mailing address

770 S GRAND AVE APT 5077
LOS ANGELES CA
90017-3949
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-7584
  • Fax:
Mailing address:
  • Phone: 310-962-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: