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General NPI Number Information
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NPI Number | 1295138642
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTH SOLUTIONS
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 245 TERRACINA BLVD SUITE 211B
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City | REDLANDS
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State | CA
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Zip | 92373-4852
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Country | US
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Telephone | 909-709-6826
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Fax | 909-798-9329
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Provider Business Mailing Address
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Address Line | 245 TERRACINA BLVD SUITE 211B
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City | REDLANDS
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State | CA
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Zip | 92373-4852
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Country | US
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Telephone | 909-709-6826
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Fax | 909-798-9329
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SHELLEE LAZAR
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Credential | MD
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Telephone | 909-709-6826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A66921
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License Number State | CA
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