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General NPI Number Information
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NPI Number | 1003430794
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Entity Type | Individual
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Provider Name | DARVIN LEVAR PHILLIPS JR.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 13423 BLANCO RD STE 593
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City | SAN ANTONIO
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State | TX
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Zip | 78216-2187
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Country | US
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Telephone | 253-525-4457
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Fax |
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Provider Business Mailing Address
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Address Line | 13423 BLANCO RD STE 593
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City | SAN ANTONIO
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State | TX
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Zip | 78216-2187
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Country | US
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Telephone | 253-525-4457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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