MEDICARE: DANIELLE PHILLIPPS RD

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1477393072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PHILLIPPS RD

Provider Business Mailing Address
First Line	:	1020 LAKE ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 LAKE ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3562
Country	:	US
Telephone Number	:	714-235-7562
Fax Number	:

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

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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Directions to “ DANIELLE PHILLIPPS RD” Practice Location

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