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General NPI Number Information
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NPI Number | 1366080475
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Entity Type | Individual
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Provider Name | MADISON TAYLOR PHILLIPS MSW
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Gender | Female
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 15741 BERING ST
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City | EHRENBERG
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State | AZ
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Zip | 85334-0010
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Country | US
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Telephone | 619-857-6897
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82
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City | EHRENBERG
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State | AZ
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Zip | 85334-0082
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Country | US
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Telephone | 619-857-6897
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 91820
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License Number State | CA
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