Healthcare Provider Details

I. General information

NPI: 1588792527
Provider Name (Legal Business Name): ANTHONY W PHILLIPS RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

IV. Provider business mailing address

9707 MAGNOLIA AVE
RIVERSIDE CA
92503-3609
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6858
  • Fax: 951-687-3478
Mailing address:
  • Phone: 951-358-6858
  • Fax: 951-687-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN483612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: