Individual
STACY PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
571 ROCKROSE CT, INCLINE VILLAGE, NV 89451-8300
(805) 704-7193
Mailing address
PO BOX 124, MOFFETT FIELD, CA 94035-0124
(805) 704-7193
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
NU100000198
DC
Other
Enumeration date
12/05/2017
Last updated
07/27/2020
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