MEDICARE: DEONTE 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
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1972153088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEONTE PHILLIPS

Provider Business Mailing Address
First Line	:	3360 ATHENS ST APT 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2862
Country	:	US
Telephone Number	:	702-936-1142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 W FLAMINGO RD STE 25AB
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3705
Country	:	US
Telephone Number	:	702-871-9917
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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Directions to “ DEONTE PHILLIPS ” Practice Location

Language	Start Address	Practice Location

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