Individual
CHARLES PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
159 BRENTWOOD DR, GRASS VALLEY, CA 95945-5703
(530) 263-2914
Mailing address
159 BRENTWOOD DR, GRASS VALLEY, CA 95945-5703
(530) 263-2914
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-OTLYJA
CA
Other
Enumeration date
06/21/2025
Last updated
06/21/2025
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