Healthcare Provider Details

I. General information

NPI: 1255007605
Provider Name (Legal Business Name): ASHLEY PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 PAJARO ST
SALINAS CA
93901-3459
US

IV. Provider business mailing address

6987 ROCKTON PL
SAN JOSE CA
95119-1331
US

V. Phone/Fax

Practice location:
  • Phone: 800-214-5439
  • Fax:
Mailing address:
  • Phone: 408-497-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW98722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: