Provider Demographics
NPI:1114254372
Name:PHILLIPS, SHARI LEIGH (LAC)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LEIGH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N CONEJO SCHOOL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2664
Mailing Address - Country:US
Mailing Address - Phone:805-405-8828
Mailing Address - Fax:
Practice Address - Street 1:205 N CONEJO SCHOOL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2664
Practice Address - Country:US
Practice Address - Phone:805-405-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12716171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist