Individual
MR. MONELL PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1850 S DELEON AVE, TITUSVILLE, FL 32780-7733
(321) 264-5000
Mailing address
1850 S DELEON AVE, TITUSVILLE, FL 32780-7733
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001165600
—
FL
Enumeration date
10/22/2012
Last updated
10/22/2012
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