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Individual

MR. ELIJAH RYAN PHOENIX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
1100 W STEWART DR, ORANGE, CA 92868-3849
(618) 919-0972
Mailing address
9951 HOLDER ST APT 49, CYPRESS, CA 90630-4009
(618) 919-0972

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95232470
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95032063
CA

Other

Enumeration date
01/15/2025
Last updated
01/15/2025
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