Healthcare Provider Details

I. General information

NPI: 1457707929
Provider Name (Legal Business Name): IRVING JAMES PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax: 530-758-8490
Mailing address:
  • Phone: 530-758-2060
  • Fax: 530-758-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA167811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: