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NPI Code Detail

MEDICARE: CHRISTOPHER DEANDRE PHILLIPS

MEDICARE: CHRISTOPHER DEANDRE 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
1225400000XRehabilitation Practitioner
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1699829853
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER DEANDRE PHILLIPS
Provider Business Mailing Address
First Line : 3850 CRENSHAW BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-1821
Country : US
Telephone Number : 323-751-3026
Fax Number :
Provider Business Practice Location Address
First Line : 3850 CRENSHAW BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90008-1821
Country : US
Telephone Number : 323-751-3026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 06/07/2021

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Directions to “ CHRISTOPHER DEANDRE PHILLIPS ” Practice Location

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