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NPI Code Detail

MEDICARE: DR. JOLLY PHILIP

MEDICARE: DR. JOLLY PHILIP
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
1207Q00000XFamily Medicine PhysicianC52441CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487653556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOLLY PHILIP
Provider Business Mailing Address
First Line : 3400 DATA DR
Second Line : ATTN: CREDENTIALING/PAYER ENROLLMENT
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 SHOREWAY RD STE 100
Second Line :
City : BELMONT
State : CA
Zip : 94002-4110
Country : US
Telephone Number : 650-596-7000
Fax Number : 650-596-7093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 01/04/2022

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Directions to “ DR. JOLLY PHILIP ” Practice Location

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