Organization
PHS MEDICAL INC
Active
Organization
PHS MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY JAMES STACY DNP, ACNP-BC (CEO)
(805) 208-0434
Entity
Organization
Contact information
Practice address
5268 HUCKLEBERRY OAK ST, SIMI VALLEY, CA 93063-4503
(805) 208-0434
(805) 578-2371
Mailing address
5268 HUCKLEBERRY OAK ST, SIMI VALLEY, CA 93063-4503
(805) 208-0434
(805) 578-2371
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
NP15005
CA
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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