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NPI Code Detail

MEDICARE: CRYSTAL ANN PHILLIPS SUDRC-1

MEDICARE: CRYSTAL ANN PHILLIPS SUDRC-1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorSUDRCI23113CA

General Provider Information

NPI Number : 1013876606
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL ANN PHILLIPS SUDRC-1
Provider Business Mailing Address
First Line : 1100 SPORTFISHER DR
Second Line :
City : OCEANSIDE
State : CA
Zip : 92054-2550
Country : US
Telephone Number : 760-439-6702
Fax Number :
Provider Business Practice Location Address
First Line : 1100 SPORTFISHER DR
Second Line :
City : OCEANSIDE
State : CA
Zip : 92054-2550
Country : US
Telephone Number : 760-439-6702
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ CRYSTAL ANN PHILLIPS SUDRC-1” Practice Location

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