Provider Demographics
NPI:1215577168
Name:PHYLLIS MO, DO, INC
Entity Type:Organization
Organization Name:PHYLLIS MO, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-920-3838
Mailing Address - Street 1:1021 E WALNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1479
Mailing Address - Country:US
Mailing Address - Phone:626-658-8697
Mailing Address - Fax:
Practice Address - Street 1:1021 E WALNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1479
Practice Address - Country:US
Practice Address - Phone:626-658-8697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty