Healthcare Provider Details

I. General information

NPI: 1902740434
Provider Name (Legal Business Name): LYNDON BB JUNIO PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LYNDON PHILLIPS

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 ALAMOS AVE
CLOVIS CA
93611-5032
US

IV. Provider business mailing address

2660 ALAMOS AVE
CLOVIS CA
93611-5032
US

V. Phone/Fax

Practice location:
  • Phone: 559-330-8295
  • Fax:
Mailing address:
  • Phone: 559-330-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: