Healthcare Provider Details

I. General information

NPI: 1700515780
Provider Name (Legal Business Name): PHOEBE MARY MISSIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 W MISSION AVE
ESCONDIDO CA
92025-1729
US

IV. Provider business mailing address

3611 CHAIN BRIDGE RD STE C&D
FAIRFAX VA
22030-3246
US

V. Phone/Fax

Practice location:
  • Phone: 760-745-0281
  • Fax: 760-745-0778
Mailing address:
  • Phone: 703-380-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: