Provider Demographics
NPI:1336132422
Name:PHILLIPS, CATHERINE MCCLAIN (PA C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MCCLAIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30125 AGOURA RD
Mailing Address - Street 2:STE 200
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4337
Mailing Address - Country:US
Mailing Address - Phone:818-707-9603
Mailing Address - Fax:818-707-1276
Practice Address - Street 1:3605 ALAMO ST
Practice Address - Street 2:STE 100
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2186
Practice Address - Country:US
Practice Address - Phone:805-522-6577
Practice Address - Fax:805-522-7030
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR630XMedicare PIN
P93593Medicare UPIN