Healthcare Provider Details

I. General information

NPI: 1003952151
Provider Name (Legal Business Name): TANYANIKA PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. TANYANIKA PHILLIPS TOWE

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44151 15TH ST W STE 101
LANCASTER CA
93534-4079
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 661-902-5600
  • Fax: 661-951-0686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35601
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number28718
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC157739
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC157739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: