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NPI Code Detail

MEDICARE: PHILIP JAMES SCULLY

MEDICARE: PHILIP JAMES SCULLY
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
1103K00000XBehavior Analyst1-19-35332CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-19-35332OTHERCABACB

General Provider Information

NPI Number : 1124588025
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP JAMES SCULLY
Provider Business Mailing Address
First Line : 6480 KATHERINE RD SPC 10
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93063-6454
Country : US
Telephone Number : 805-428-5304
Fax Number :
Provider Business Practice Location Address
First Line : 2625 TOWNSGATE RD STE 102
Second Line :
City : WESTLAKE VILLAGE
State : CA
Zip : 91361-5726
Country : US
Telephone Number : 818-285-8252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2019
Last Update Date : 07/25/2024

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