MEDICARE: RAMEIKA PHILLIPS-MASHACK MSW

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1073875381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMEIKA PHILLIPS-MASHACK MSW

Provider Business Mailing Address
First Line	:	3305 N. LAUREL AVE
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92377
Country	:	US
Telephone Number	:	909-437-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2527 PARASAIL PT.
Second Line	:
City	:	N. LAS VEGAS
State	:	NV
Zip	:	89031
Country	:	US
Telephone Number	:	909-437-8662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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