Healthcare Provider Details

I. General information

NPI: 1205002235
Provider Name (Legal Business Name): JOANNA J. PHILLIPS MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE M551, BOX #0102
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE M551, BOX #0102
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5236
  • Fax: 415-476-7963
Mailing address:
  • Phone: 415-476-5236
  • Fax: 415-476-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberA86595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: