Healthcare Provider Details

I. General information

NPI: 1114254372
Provider Name (Legal Business Name): SHARI LEIGH PHILLIPS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N CONEJO SCHOOL RD SUITE 208
THOUSAND OAKS CA
91362-2664
US

IV. Provider business mailing address

205 N CONEJO SCHOOL RD SUITE 208
THOUSAND OAKS CA
91362-2664
US

V. Phone/Fax

Practice location:
  • Phone: 805-405-8828
  • Fax:
Mailing address:
  • Phone: 805-405-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC12716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: