Healthcare Provider Details

I. General information

NPI: 1932937257
Provider Name (Legal Business Name): PHLEX65 INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 LINCOLN AVE
SAN JOSE CA
95125-3155
US

IV. Provider business mailing address

PO BOX 26593
SAN JOSE CA
95159-6593
US

V. Phone/Fax

Practice location:
  • Phone: 408-828-1511
  • Fax:
Mailing address:
  • Phone: 408-828-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. ANA LIKUBIAU JONES
Title or Position: FOUNDER
Credential: GERONTOLOGY SPECIALI
Phone: 408-828-1511