Provider Demographics
NPI:1265488167
Name:PHILLIPS, ZINA (PA)
Entity Type:Individual
Prefix:MS
First Name:ZINA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LOOP
Mailing Address - Street 2:MEDDAC MEWC; GOLD TEAM
Mailing Address - City:FT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-6278
Mailing Address - Fax:760-380-4409
Practice Address - Street 1:4 LOOP
Practice Address - Street 2:
Practice Address - City:FT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-6278
Practice Address - Fax:760-380-4409
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0050901Medicaid
CAGR0050901Medicaid