Individual
KELLY PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4650 FRUITVALE RD, NEWCASTLE, CA 95658-9240
(530) 488-0713
Mailing address
4650 FRUITVALE RD, NEWCASTLE, CA 95658-9240
(530) 488-0713
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
Z3756
CA
1744G0900X
Graphics Designer
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—
Other
Enumeration date
06/27/2020
Last updated
06/27/2020
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