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NPI Code Detail

MEDICARE: JEFFERY PHILLIPS

MEDICARE: JEFFERY PHILLIPS
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
1106S00000XBehavior TechnicianRBT-23-272431CA

General Provider Information

NPI Number : 1154105989
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY PHILLIPS
Provider Business Mailing Address
First Line : 14781 POMERADO RD UNIT 11
Second Line :
City : POWAY
State : CA
Zip : 92064-2802
Country : US
Telephone Number : 858-967-1437
Fax Number : 858-800-2570
Provider Business Practice Location Address
First Line : 9565 WAPLES ST STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-2973
Country : US
Telephone Number : 858-967-1437
Fax Number : 858-800-2570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2023
Last Update Date : 08/22/2023

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Directions to “ JEFFERY PHILLIPS ” Practice Location

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