Provider Demographics
NPI:1043785710
Name:PHILLIPS, STEVE KEITH (PA-S)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:KEITH
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:KEITH
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2243 GREEN HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2743
Mailing Address - Country:US
Mailing Address - Phone:760-458-9413
Mailing Address - Fax:
Practice Address - Street 1:2243 GREEN HILLS WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2743
Practice Address - Country:US
Practice Address - Phone:760-458-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant