Healthcare Provider Details

I. General information

NPI: 1396745501
Provider Name (Legal Business Name): GEOFFREY B. PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARKCENTER DR SUITE 206
SANTA ANA CA
92705-3522
US

IV. Provider business mailing address

601 PARKCENTER DR SUITE 206
SANTA ANA CA
92705-3522
US

V. Phone/Fax

Practice location:
  • Phone: 714-453-0688
  • Fax: 714-453-0691
Mailing address:
  • Phone: 714-453-0688
  • Fax: 714-453-0691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: